This paper presents an analog front-end transceiver for an ultrasound imaging system based on a high-voltage (HV) transmitter, a low-noise front-end amplifier (RX), and a complementary-metal-oxide-semiconductor, aluminum nitride, piezoelectric micromachined ultrasonic transducer (CMOS-AlN-PMUT). The system was designed using the 0.13-μm Silterra CMOS process and the MEMS-on-CMOS platform, which allowed for the implementation of an AlN PMUT on top of the CMOS-integrated circuit. The HV transmitter drives a column of six 80-μm-square PMUTs excited with 32 V in order to generate enough acoustic pressure at a 2.1-mm axial distance. On the reception side, another six 80-μm-square PMUT columns convert the received echo into an electric charge that is amplified by the receiver front-end amplifier. A comparative analysis between a voltage front-end amplifier (VA) based on capacitive integration and a charge-sensitive front-end amplifier (CSA) is presented. Electrical and acoustic experiments successfully demonstrated the functionality of the designed low-power analog front-end circuitry, which outperformed a state-of-the art front-end application-specific integrated circuit (ASIC) in terms of power consumption, noise performance, and area.