Abstract: Objective To analyze ultrasonography imaging feature of intravenous leiomyomatosis (IVL) and improve its diagnosis. Methods Clinical data and ultrasonography imaging feature of 29 female patients aged 23-73 years with pathologically confirmed IVL in Chinese PLA General Hospital from May 2000 to June 2015 were retrospectively analyzed. Results Of the 10 recurrent patients, 8 patients underwent previously hysterectomy and 2 patients underwent previously myomectomy due to probable diagnosis of hysteromyoma. Of the 29 patients, 8 patients had a history of hysterectomy, 2 lesions was confined in pelvis, 2 lesions extended into iliac vein, 1 lesion extended into inferior vena cava, and 3 lesions extended into right atrium. Of the remaining 21 cases, 12 was confined in uterus, 6 lesions extended into pelvis venous, 2 lesions extended into inferior vena cava, and 1 lesion extended into right atrium. Ultrasonographic manifestations of IVL in 29 patients: solid or cystic solid occupied lesions were found in pelvis after hysterectomy, or the lesion extended into pelvic vein, iliac vein, inferior vena cava and right atrium at the same time. Uterine solid lesions or uneven internal echo of uterus were found, or the lesion extended into pelvic vein, inferior vena cava and right atrium.Of the 29 cases, 19 (65.5%) cases were correctly diagnosed by ultrasound, 3 (10.3%) cases were indeterminate, while 7 (24.1%)cases were misdiagnosed. Conclusion Ultrasonography imaging has certain characteristics. Ultrasound can accurately show the size, involving scope, internal echo and blood flow of lesions, which can be as the first choice of imaging methods for preoperative diagnosis and postoperative follow-up of IVL.