Background: The present study was done to emphasize the importance of ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) in the diagnosis of abdominal tuberculosis. Methods: Sixty-six proven cases of abdominal tuberculosis were selected for this study. The diagnosis was based on clinical features, US observations, FNAB, operative findings, and responses to appropriate antitubercular treatment. The US findings were interpreted with regard to the involvement of lymph nodes, intestine, peritoneum, solid viscera, and abdominal abscesses. Patients with disease limited to the musculoskeletal and genitourinary systems were not included in the study. Results: Peritoneal tuberculosis was the most common form, of the “wet” ascitic type. Ascites was clear in 19 patients and complex in 17. Tuberculous lymphadenopathy was seen in 37 patients. There was a predilection of periportal, peripancreatic, and mesenteric locations compared with the degree of retroperitoneal involvement. Calcification and heterogeneous echotexture were seen in seven cases. FNAB confirmed the diagnosis of tubercular lymphadenopathy in 19 patients. Intestinal disease was seen in 14 patients. Hepatic or splenic involvement was seen as diffuse organomegaly; less commonly, focal lesions were seen. Conclusion: This combination of US findings in proper clinical settings are diagnostic of tuberculosis. FNAB confirms the diagnosis in lymphadenopathy, abscesses, and focal lesions of the viscera.