Gout represents a common inflammatory arthritis conditions in which the monosodium urate (MSU) crystals are deposited in joints and other tissues producing attacks of acute arthritis/ chronic arthropathy with important destructive lesions in articular or juxta-articular spaces. High resolution ultrasonography (US) is able to detect these deposits and their consequences: hyaline cartilage pathology, joint effusions, synovitis, bone erosions, tendons, bursitis, and other soft tissues involvement. Moreover, there are characteristic findings of this aggregates that can be detected by US, helping the clinician for positive and differential diagnosis. In this review we will present the main US findings in gout. The utility of the method in diagnosis and treatment response will be discussed. Also, comparison with other imaging techniques in terms of sensibility and specificity of the methods for this pathological situation will be made.