Abstract Objective To observe the ultrasound manifestations of calcium pyrophosphate deposition disease (CPPD) and gouty arthritis (GA), and to explore the application value of ultrasound in differentiating CPPD from GA. Methods The general data and ultrasound findings of 82 CPPD patients and 61 GA patients in our hospital were collected, and the differences between the two groups were compared. Results CPPD and GA were different in age and gender (P<0.05), women with CPPD were more common, men with GA were more common, and elderly patients with CPDD (>65 years old). The most common site of CPPD is the knee joint, and the most common site of GA is the first metatarsophalangeal joint. The number of people involved in polyarticular joints in GA group was more than that in CPPD group, but CPPD had a more symmetrical tendency of involvement (P<0.05). The CPPD group had a higher incidence of cartilage calcification, a higher incidence of GA double-track sign, bone erosion, tophi, tendon and ligament hyperechoic incidence (P < 0.05), but no significant difference in synovial hyperechoic incidence between the two groups(P>0.05).The incidences of meniscus degeneration, cartilage damage, bone cortical irregularity, bursitis, synovial thickening, and soft tissue swelling were significantly different between the two groups (P< 0.05) , tenosynovitis, hydrocele, and tendinopathy had no significant difference (P>0.05). Conclusion Ultrasound can clearly show the structural abnormalities of CPPD and GA joints, which can provide reference for clinical diagnosis.