Ultrasound (US) imaging has been proposed as a noninvasive tool for monitoring liver dysfunction in dairy cows. This study, carried out on 306 clinically healthy Holstein cows in the first 120 d of lactation kept in 2 herds in northern Italy, aimed at investigating the association between US imaging-derived traits, namely predicted liver triacylglycerol content (pTAG, mg/g), liver depth (LD, mm), portal vein depth (PVD, mm) and area (PVA, mm 2 ), and body size measurements, body condition score (BCS), and milk productivity indicators. Transcutaneous US examination, milk sampling, body size measurements (withers height and heart girth), and BCS were collected once from all cows in 10 sampling batches. The body weights (BW) of a subsample of 73 cows were recorded and used together with an existing data set of BW and measures of Holstein Friesian cows (n = 399) to develop a regression equation to predict BW, which was then used to compute productivity indicators by scaling the milk production traits to predicted BW. Body size measures, BCS, milk traits, and productivity indicators were classified (low, medium, and high) in 0.75 units of standard deviation of the residuals generated from a linear model that included the effects of parity, days in milk, and sampling batch. Liver pTAG, PVA, PVD, and LD were analyzed with a sequence of linear mixed models that included the fixed effects of days in milk and parity and the random effect of sampling batch as common terms, whereas the classes of body and milk traits and the productivity indicators were included one by one. The US-related traits were found to be associated with body size measurements and BCS. Specifically, pTAG was inversely related to BCS, whereas PVD and LD in-creased with increasing heart girth, BCS, and predicted BW. Generally, no relevant associations were observed between the US parameters and milk production traits, including when expressed in terms of productivity. In conclusion, this study suggests that US measures of liver dimensions of clinically healthy cows are related to their size, whereas pTAG concentrations reflect body condition status, with no particular implications for milk production and productivity. Moreover, healthy cows seemed able to counteract the metabolic stress of the first 120 d of the lactation period without straining liver functionality. Finally, US imaging proved to be a promising technique to assess liver metabolic conditions. However, further studies are needed to confirm its potential as a noninvasive tool for monitoring liver conditions in healthy cows.