Contrast-enhanced ultrasound (CEUS) has become an important tool for the detection and characterization of solid renal lesions, complementing traditional B-mode US, which often struggles to distinguish between solid and cystic masses. CEUS enhances diagnostic accuracy by providing detailed vascularization information, helping to identify potentially malignant solid lesions and differentiate between pseudotumours and solid masses. Moreover, CEUS employs a contrast agent that is safe even for nephropathic patients and can be used without concern for kidney function, making it an advantageous method for renal imaging. In this narrative review, following the European Federation of Societies for Ultrasound in Medicine and Biology guidelines, the authors show its main indications: characterizing indeterminate renal lesions in patients with transplanted kidney, monitoring non-surgical lesions, diagnosing inflammatory-infectious renal pathologies, and assessing advanced renal lesions and masses in the surgical bed.
