Background:The COVID-19 pandemic has Necessitated efficient and accurate diagnostic methods for COVID-19 pneumonia. While chest computed tomography (CT) and lung ultrasound (LUS) have shown promise in this context, their comparative performance needs further evaluation.Objective:To compare the diagnostic performance of chest CT and LUS for detecting COVID-19 pneumonia, focusing on sensitivity, specificity, and practical feasibility. Methods:A total of 185 patients with confirmed or suspected COVID-19 underwent both chest CT and LUS within 48 hours of admission. Imaging findings were compared against RT-PCR results as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each modality. Statistical analyses included agreement evaluation using Cohen’s kappa coefficient and subgroup analysis by disease severity.Results:Chest CT demonstrated higher sensitivity (93.2%) compared to LUS (87.8%), while LUS showed slightly higher specificity (81.1% vs. 78.4%). Overall diagnostic accuracy was 89.7% for chest CT and 86.5% for LUS. Substantial agreement between modalities was observed (Cohen’s kappa = 0.81). LUS was faster (average 12 minutes vs. 25 minutes for CT) and more feasible for point-of-care use, but CT provided better visualization of deep lung abnormalities.Conclusion:It is concluded that chest CT and LUS are both effective for diagnosing COVID-19 pneumonia, with CT offering superior sensitivity and detailed imaging, and LUS excelling in practicality and accessibility. The choice of modality should depend on clinical context and resource availability, with a combined approach potentially enhancing diagnostic accuracy.