Introduction: To describe the value of contrast-enhanced ultrasound (CEUS) for the differentiation of malignant from benign parietal pleural lesions (PPLs).Materials and Methods: From November 2005 to June 2019, 63 patients with histologically/cytologically confirmed PPLs were investigated by CEUS. On CEUS, the extent of enhancement (EE; marked or reduced/absent) and the homogeneity of enhancement (HE; homogeneous or inhomogeneous) were analyzed retrospectively.Results: In total, 24/63 lesions were benign, and 39/63 lesions were malignant. On CEUS, 11/24 benign and 36/39 malignant lesions showed a marked enhancement.A marked enhancement was significantly more frequently associated with malignancy compared with benign lesions (p < 0.001). In five cases, due to the absence of enhancement, it was not possible to determine the HE. In the remaining cases, 9/20 benign and 19/38 malignant lesions showed an inhomogeneous enhancement (p = 0.79). Conclusion:On CEUS, marked enhancement was significantly more frequently associated with malignant compared with benign lesions. However, some benign lesions, such as chronic inflammatory processes, may also show a marked enhancement.Therefore, the interpretation of perfusion patterns in these lesions must always take into account the clinical background of the patient.