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Chest pain (CP) and abdominal pain (AP) are frequent complaints in emergency medicine. The issue with etiologic diagnosis is linked to the fact that there are many possible causes, some of which are critical, but none are common. While the systematic use of point-of-care ultrasound (PoCUS) in these contexts may be debatable, its diagnostic performance and clinical utility support its targeted integration into the diagnostic approach. On the one hand, it improves diagnostic accuracy for certain conditions responsible for CP and AP, and enhances clinical semiology with contextualized ultrasound findings. On the other hand, it impacts the overall diagnostic process, particularly by refining the differential diagnosis, guiding therapeutic decisions, and reducing the need for additional tests. In emergency settings, its effect on the duration of care is another factor that determines the appropriateness of its use. Its impact on morbidity, mortality, and patient satisfaction could further underscore its clinical relevance. This review aims to explore the diagnostic performance of PoCUS in the contexts of CP and AP, while discussing its clinical utility. It thus offers a reflection on the optimal role of PoCUS within emergency departments for these nosological conditions.