Objective Bladder Leiomyoma is a benign bladder tumor with a very low incidence, which is derived from mesenchymal tissue. We discuss the ultrasonographic features of bladder leiomyoma in order to help with the correct diagnosis. Methods 16 cases of patients with bladder leiomyoma were reviewed which were hospitalized in Union Hospital of Fujian Medical University during 2003 to 2018. All of the patients underwent ultrasound examinations before surgery, analysis of ultrasound images and pathological results. Results All 16 cases are single lesion in the bladder wall, with clear boundary and wide base, ultrasound shows bladder leiomyoma as a solid flat hypoechoic tumor with hyperechoic mucosal lining.The continuity of the bladder wall is still complete. Circular shape was in 11 cases, 4 cases were oval and 1case was lobulated. Blood signals were found in 5 cases, while 11 cases showed no signals. Ultrasonic diagnosis bladder cancer in 5 cases, bladder benign tumor in 4 cases, diagnosis is not positive in 7 cases. Conclusions There are some specific characteristics of bladder leiomyoma in ultrasound images, such as the surface of the leiomyoma is covered with complete mucous membranes. Inspectors should strengthen the understanding of the disease, improve the diagnostic coincidence rate and provide help for clinical treatment.