Focal liver lesions (FLL) are a heterogeneous group of solid or cystic formations often discovered incidentally during abdominal ultrasound examinations. Considering the prevalence of benign FLLs in the general population is around 15%, the ability to quickly and accurately distinguish them from malignant lesions is of great importance. This paper aims to provide an overview of the diagnostic capabilities of contrast-enhanced ultrasound (CEUS) for FLLs. Contrast-enhanced ultrasound involves the use of intravenous ultrasound contrast agents composed of microbubbles filled with gaseous sulfur hexafluoride. After intravenous administration, three specific vascular phases (arterial, portal venous, and late phases) can be distinguished due to the liver's dual blood supply from the hepatic artery and portal vein. The most common benign liver lesions include hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and focal fatty infiltration (hypersteatosis), or focal fatty sparing (hyposteatosis, FFS). Malignant FLLs are categorized into more common primary lesions (with hepatocellular carcinoma and cholangiocarcinoma being the most prevalent) and secondary lesions (metastases), with the latter being significantly more frequent than the former. In addition to solid liver lesions, cystic FLLs are also identified. Malignant lesions are typically hypervascular in the arterial phase (either completely or partially) due to abundant arterial supply, whereas in the portal venous and especially in the late phase, they exhibit a washout phenomenon. Benign lesions do not exhibit the washout phenomenon in the portal venous and late phases. Multiple studies and meta-analyses confirm the ability of contrast-enhanced ultrasound to distinguish between benign and malignant FLLs with significantly higher sensitivity and specificity compared to conventional ultrasound. Furthermore, the sensitivity and specificity of CEUS are comparable to those of CT and MRI. Regarding the differential diagnosis of lesions, CEUS has proven particularly useful for the definitive characterization of benign liver lesions, whereas the confirmation of malignant lesions often requires additional diagnostic methods. Contrast-enhanced ultrasound represents a valuable diagnostic tool that can exclude malignancy and characterize benign lesions in a large number of cases. This offers multiple benefits for patients, including faster diagnosis and reduced exposure to ionizing radiation, as well as for the healthcare system by reducing numerical and financial burdens.