Ultrasound imaging is a cornerstone of non-invasive clinical diagnostics, yet its limited field of view poses challenges for novel view synthesis. We present UltraGS, a real-time framework that adapts Gaussian Splatting to sensorless ultrasound imaging by integrating explicit radiance fields with lightweight, physics-inspired acoustic modeling. UltraGS employs depth-aware Gaussian primitives with learnable fields of view to improve geometric consistency under unconstrained probe motion, and introduces PD Rendering, a differentiable acoustic operator that combines low-order spherical harmonics with first-order wave effects for efficient intensity synthesis. We further present a clinical ultrasound dataset acquired under real-world scanning protocols. Extensive evaluations across three datasets demonstrate that UltraGS establishes a new performance-efficiency frontier, achieving state-of-the-art results in PSNR (up to 29.55) and SSIM (up to 0.89) while achieving real-time synthesis at 64.69 fps on a single GPU. The code and dataset are open-sourced at: https://github.com/Bean-Young/UltraGS.

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