We report a case of a 65-year-old man with a cavitary lung mass and parietal-based pleural nodules in which a pleural ultrasound-guided approach yielded a definitive diagnosis of stage IV non-small cell lung carcinoma. Computed tomography-guided biopsy is often preferred approach for the majority of United States hospitals for sampling pleural nodules as compared to US. The advantages of an US-guided approach include [1]: increased portability [2]; decreased procedure time [3]; reduced reliance on dedicated ancillary support staff [4]; need for local anesthesia only [5]; lack of ionizing radiation exposure; and [6] cost reduction.