The assessment of patients with pulmonary focal abnormalities continues to represent an important problem in pulmonary diagnosis. A large number of lung nodules remains undetermined after bronchoscopy, radiological and CT imaging analysis. Ultrasound can contribute to the determination of the nature of peripheral lung tumors, serving as an important aid in decision-making. It helps the investigator to decide the appropriate subsequent step in order to establish the etiologic diagnosis: another imagistic investigation, ultrasonographic guided transthoracic needle biopsy or surgery. This pictorial essay summarizes the main sonographic signs of subpleural lung tumors and the differentiation of benign and malignant lesions.