Objective: To evaluate the role of real time ultrasonography in characterization of focal liver lesions. Methodology: Real time ultrasonography was performed in 40 patients with suspected of having focal liver lesions attending the Department of Radiodiagnosis, Govt. Medical College, Bettiah, W. Champaran, Bihar, over a period of one year (November 2018 to October 2019). Results: Of the 40 patients, 26 were male (65%) and 14 were female (35%). Focal liver lesions were common in the age group between 50 – 60 years with 10 patients (25%). Out of 40 patients Hemangioma was the most common lesion with an incidence of 25%, followed by metastases (20%), liver abscess (17.5%), hepatic cysts (15%), primary malignant liver tumor (12.5%), Hydatid lesion (7.5%) and cholangiocarcinoma (2.5%). Abdominal pain and fever were the most common clinical features, followed by loss of weight and appetite. Right lobe of liver was predominantly involved with (75%), followed by both lobes (17.5%) and left lobe (12.5%). Solitary lesions were common (75%) than multiple lesions (25%). Conclusion: Real time Sonography is a comprehensive, multiplanar, non invasive, safe diagnostic modality for characterization of focal liver lesions.