Ultrasound is a valuable imaging modality for evaluating chest wall pathologies in newborns. Technological advancements and concerns about cumulative ionizing radiation exposure in children have expanded its role. Additionally, the smaller patient size and acoustic windows provided by unossified cartilage allow for detailed real-time assessment. Neonatal chest ultrasound utilizes high-frequency linear transducers and various approaches, including intercostal, parasternal, subxiphoid, and posterior paraspinal acoustic windows. Key applications include characterizing pleural effusions, skin, breast, chest wall, and pleural lesions, as well as guiding interventions. The current clinical applications of this modality to evaluate the chest wall and pleura in neonates are reviewed in this chapter.