Abdominal wall hernias are the common pathology in the surgical practice. Clinical data do not always indicate a correct diagnosis, and the ultrasound image might be doubtable. This requires the choice of methodological aspects of the examination for the successful search for specific ultrasound symptoms for differential diagnosis. Purpose. The choice of methodological techniques and clarification of ultrasound signs for differential diagnosis of fat-containing hernias of the anterior abdominal wall. Materials and methods. Over a three-year period, the ultrasound examinations were performed for 52 patients with various anterior abdominal wall hernias, using a standard ultrasound procedure and specific tests to analyze the hernial contents. There were used the B-mode ultrasound scanning and the color Doppler Imaging mode. Most of the patients were subsequently subjected to routine surgical operations followed by dynamic ultrasound follow-up. Results and discussion. The ultrasound method made it possible to detect hernias in most of patients at standard examination and in all patients during the Valsalva maneuver. The fat content was identified by revealing the typical echogenicity and structure. Visualization of the parietal peritoneum and the typical respiratory motion of abdominal structures are recognized as the main ultrasound signs that allow differentiating various types of fat-containing hernias. The successful ultrasound imaging of hernias is possible in most of patients. Standardization of the methodological approach and morphometry are the important conditions for successful diagnosis and differential diagnosis of fat-containing abdominal wall hernias. Conclusion. The ultrasound method is highly informative for the search, diagnosis and differential diagnosis of abdominal wall hernias. A purposeful search for specific ultrasound symptoms allows making the correct diagnosis, which is of great importance for the timely beginning of adequate treatment.