B-scan ultrasonography is an important diagnostic modality in ophthalmology for evaluation of posterior segment pathologies particularly when visualization of the fundus is obscured by opaque media. Choroidal diseases include detachments, tumors, and inflammatory conditions that may lead to significant visual morbidity if not diagnosed early. B-scan provides real-time cross-sectional imaging and plays a vital role in diagnosis and differentiation of diseases. Aim: To evaluate the role of B-scan ultrasonography in diagnosing of choroidal diseases in patients with and without opaque media. Material and Methods: A hospital-based observational cross-sectional study was conducted in the Department of Ophthalmology, JLN Medical College and Associated Hospitals, Ajmer, Rajasthan, from March 2024 to March 2025. Thirty patients of all age groups with suspected choroidal pathology were included after informed consent. Patients underwent detailed clinical evaluation followed by B-scan ultrasonography using a standard ultrasound unit. Data were analyzed using descriptive statistics and expressed as percentages and proportions. Results: The mean age of patients was 51.0 ± 21.23 years, with maximum cases in the 30–60 years age group (46.67%). Males constituted 76.67% of cases and 70% cases belonged to rural areas. Ocular trauma was the most common predisposing factor (50%) followed by cataract surgery (13.33%). Low intraocular pressure (<10 mmHg) was observed in 76.67% of patients. Choroidal detachment was the most common lesion detected (90%) while choroidal masses accounted for 10% of cases. The most common diagnosis was choroidal detachment (40%), followed by choroidal detachment with retinal detachment (16.67%), choroidal detachment with retinal detachment and vitreous hemorrhage (13.33%), and choroidal tumors including melanoma (6.67%). Conclusion: B-scan ultrasonography is a reliable and indispensable diagnostic tool for evaluation of choroidal diseases, particularly in eyes with opaque media. Choroidal detachment was the most common pathology and was frequently associated with hypotony, trauma, and postoperative states. B-scan effectively identified associated retinal and vitreous abnormalities as well as intraocular tumors.