Objective To evaluate the application value of convolutional neural network (VGG19) model in the ultrasound diagnosis of hepatic cystic echinococcosis (HCE). Methods The ultrasound images of patients with hepatic cystic echinococcosis (HCE, including CE1-CE5 types) and patients with non-echinococcosis focal liver lesions (NHFLL) in the First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2022 were retrospectively collected. The VGG19 model was used to determine the image diagnosis of 6 types of hepatic focal space occupying lesions (CE1-CE5, NHFLL), and the percentage of each type determined was compared. When VGG19 misclassified HCE and NHFLL, the general demographic information and relevant clinical data of patients were compared. The ultrasound images were randomly divided into two groups based on the principle of essentially consistent proportion of different types, of which manual classification summary were performed by 2 junior ultrasound physicians and 2 senior ultrasound physicians on one group each selected randomly. The diagnostic accuracy of the model made by junior and senior ultrasound physicians were compared. The diagnostic performance of VGG19 was evaluated using confusion matrix, precision, recall, specificity, and F1 score. Descriptive analysis was conducted using contingency tables to describe the count data, and chi-square test， Fisher’s exact probability method and paired card square test were used for comparative analysis of differences. Results Among the 871 HCE cases, there were 203 cases of CE1, 227 of CE2, 110 of CE3, 159 of CE4, and 172 of CE5. The 600 NHFLL cases include, 300 cases of hepatic cysts, 150 of hepatic calcified lesions, and 150 solid hepatic occupying lesions (100 cases of hepatic hemangioma, 25 of hepatoma, and 25 of liver abscess). The overall accuracy of the VGG19 model was 82.0%, the recall rate was 87.9%, and the F1 score was 84.3%. The overall accuracy rate of VGG19 model was 86.2% (1 268/1 471), and the accuracy rates of each type from high to low were CE5 (95.3%, 164/172), CE4 (91.2%, 145/159), CE3 (89.1%, 98/110), CE1 (84.7%, 135/159), CE2 (84.6%, 192/227) and NHFLL (82.8%, 497/600), respectively. A total of 203 cases were misdiagnosed, and the misdiagnosis rate was 13.8% (203/1 471). Among them, 100 cases were misdiagnosed between HCE types, including 31 cases of CE1, 35 cases of CE2, 12 cases of CE3, 15 cases of CE4, and 8 cases of CE5. 103 cases of NHFLL were misdiagnosed as HCE, including 68 cases of hepatic cyst, 17 cases of liver calcification, 17 cases of liver hemangioma, and 1 case of liver abscess. No case of liver cancer was misdiagnosed. There were statistically significant differences in age, residential area, history of contact with dogs, education level and province between HCE patients and NHFLL patients misdiagnosed by VGG19 (χ² = 55.116, 24.197, 35.834, 14.069, 11.918, all P < 0.05), but there was no significant difference in gender (χ² = 0.047, P > 0.05). The overall diagnostic accuracy of VGG19 model (86.2%, 1 268/1 471) was higher than that by junior doctors (81.2%, 1 195/1 471) (P < 0.05), lower than that by senior physicians (92.3%, 1 358/1 471) (P < 0.05). Conclusion The VGG19 model can identify the 5 types of HCE and non echinococcal NHFLL, its diagnostic accuracy is lower than that by senior sonographers, but higher than that by junior sonographers. The model is expected to be promoted to primary hospitals to assist correction of ultrasound diagnosis in combination with clinical information.