Lung carcinoma is one of the most common tumors and the leading cause of malignancy mortality in both men and women. The treatment and prognosis of patients with lung carcinoma depend on the histology type and tumor stage at the time of diagnosis. Supraclavicular lymph node metastases are frequently present in these patients. Neck ultrasonography (US) is not included in the guidelines for the management of patients with lung carcinoma. The aim of the study was to evaluate the role of neck US in the detection of metastases in patients with proven or suspected lung carcinoma. Neck US was performed in 51 patients. US guided fine needle aspiration biopsy (FNAB) with cytology was obtained in 32 patients with enlarged supraclavicular lymph nodes with US characteristics suggestive of malignancy. Cytology was positive for malignancy in 17 patients. In 6 patients the diagnosis of neck metastases was the first evidence of lung carcinoma. Dissemination of the disease into supraclavicular lymph nodes was detected in 11 patients with known lung carcinoma, whereas metastases of other tumors were identified in 8 patients. Cytology was negative for malignancy in 7 patients. Our study demonstrated neck US to be a useful and reliable method for the evaluation of patients with lung carcinoma. Neck US combined with US-guided FNAB and cytologic analysis of suspected supraclavicular enlarged lymph nodes enabled us to detect lung carcinoma and metastases. We propose that neck US be included in the guidelines for the management of patients with proven or suspected lung carcinoma before other invasive diagnostic methods.