Nowadays, ultrasound and ultrasound-guided fine needle aspiration are recognized as essential steps for the management of thyroid nodule. For reliable ultrasound-based decision for thyroid nodule, a physician should be familiar with basic technical aspects of thyroid ultrasound and anatomy of neck, as well as sonographic features of thyroid nodules. In addition, inflammatory conditions of thyroid itself or extrathyroidal lesions may sometimes mimic thyroid malignancy, it is difficult to avoid unnecessary fine needle aspiration in clinical practice. In this article, we will illustrate sonographic anatomy of normal anterior neck and various sonographic features of neck lesions mimicking thyroid nodules.