Objective: To assess the diagnostic accuracy of high-resolution sonography in identifying abdominal wall lesions. Methodology: This cross-sectional study was conducted at Indus Medical College, Tando Mohammad Khan, from April 2022 to March 2023. Forty consecutive cases of anterior abdominal wall lesions, primarily sourced from the Department of Surgery, were enrolled. All patients underwent systematic examination using high-resolution ultrasonography employing a high-frequency probe (7-12MHz). The main variables of the study were sensitivity, specificity, true positives, and diagnostic accuracy. Surgical and histopathologic findings obtained were meticulously documented and subsequently compared with the USG findings to determine the sonography accuracy. Histopathology served as the gold standard. Data analysis was performed using SPSS version 25. Results: The mean age was 35.18 ± 2.31 years. Males accounted for 32.5% of the cases, while females accounted for 67.5%. The majority of patients (77.5%) fell within the 20-40 years age group. The most common lesions were incisional hernias (35.0%) and ventral hernias (32.5%). The most common preoperative diagnosis by histopathology was bowel loops, representing 30.0% of cases. Sensitivity and specificity were 72.7% and 71.4%, respectively. The positive predictive value (PPV) was 92.3%, and the negative predictive value (NPV) was 35.7%. The overall accuracy was 72.5%. Conclusion: High-resolution sonography proves to be a precise diagnostic imaging modality for detecting lesions of the anterior abdominal wall, exhibiting high sensitivity in distinguishing between hernias and cystic or solid abnormalities in the abdominal wall.