In some particular clinical emergencies, it is mandatory to obtain a pathological diagnosis as soon as possible and to start therapy quickly. This can be often done by means of ultrasound guided fine needle biopsy. The cases of emergency ultrasound guided fine needle biopsies and drainages performed in our Ultrasound Laboratory over the past 5 years represent 1.6% of all procedures performed on deeply located lesions. Diagnostic accuracy of emergency ultrasound guided fine needle biopsies was comparable to that obtained in routine situations. In 11/12 patients, this diagnostic procedure allowed the immediate start of proper therapy. Emergency ultrasound guided percutaneous drainage was performed in 6 patients and all of them had a successful outcome. We conclude that emergency ultrasound guided diagnostic and therapeutic procedures, although rarely necessary, can be very useful in some clinical situations. The high efficacy of these techniques is not impaired in an emergency.