Objective To explore the ultrasonic manifestations and clinical diagnostic effects of B-ultrasound in the diagnosis of uterine leiomyoma. Methods the basic data in this study came from 64 cases of uterine leiomyoma diagnosed and treated in our hospital from July 2021 to July 2022. The clinical diagnosis mode includes abdominal B-ultrasound diagnosis and vaginal B-ultrasound diagnosis. The diagnostic effect was recorded, the sensitivity, specificity and accuracy of diagnosis were calculated, and the detection performance of B-ultrasound was analyzed. Results the sensitivity, specificity and accuracy of abdominal B-ultrasound were 77.27%, 85.00% and 79.69% respectively; The sensitivity, specificity and accuracy of vaginal B-ultrasound were 93.62%, 88.24% and 92.19% respectively. Through the analysis of the diagnosis results of the two groups, it can be seen that the detection accuracy of vaginal B-ultrasound diagnosis group is higher than that of abdominal B-ultrasound diagnosis group (P<0.05). Conclusion abdominal B-ultrasound and vaginal B-ultrasound have obvious diagnostic value in the diagnosis of uterine leiomyoma, and the diagnostic effect of vaginal B-ultrasound is more significant.