Ultrasound report says echogenic liver with fatty infiltration. What does this mean? What do I need to do?

This is essentially. fat deposition throughout the liver tissue. There are numerous potential causes, for example obesity and certain medications(e.g. Steroids). Sometimes there is no identifiable cause(idiopathic) . It is generally a benign and potentially reversible condition. Speak with your doctor about potential etiologies in your case, and next steps.