Background <p>Acute abdominal pain is a common yet diagnostically challenging presentation in pediatric emergency care due to nonspecific symptoms. While ultrasound offers a safe and accessible diagnostic tool, its clinical utility and correlation with laboratory markers remain understudied in many regions, including Iran. This study aimed to evaluate the prevalence and diagnostic value of ultrasound findings and their association with clinical and laboratory indicators.</p> Methods <p>This cross-sectional study included 174 children aged 5–18 years who presented with acute abdominal pain to the emergency department of Namazi Hospital, Shiraz, Iran, between 2021 and 2022. Demographic data, clinical features, laboratory results, and ultrasound findings were recorded. Associations between sonographic abnormalities and clinical/laboratory parameters were analyzed using appropriate statistical tests.</p> Results <p>Ultrasound revealed abnormal findings in 59 (33.9%) patients. The most common sonographic diagnoses were abdominal free fluid (7.5%), appendicitis (4.6%), renal stones (2.9%), and intestinal obstruction (2.9%). Right lower quadrant pain and elevated CRP levels (&gt; 20&#xa0;mg/L) were significantly associated with appendicitis (<i>p</i> = 0.018 and <i>p</i> = 0.012, respectively). Positive urine protein and blood were significantly associated with renal stones (<i>p</i> = 0.01 and <i>p</i> = 0.003). The majority (79.3%) of ultrasounds were normal, highlighting the role of clinical assessment in determining the necessity of imaging.</p> Conclusions <p>Ultrasound is a valuable diagnostic tool in pediatric patients with acute abdominal pain, identifying both common and rare conditions. The study highlights the importance of clinical assessment in determining the need for further imaging and the necessity of localized research to inform diagnostic protocols in regional healthcare settings.</p>