Objective To explore the clinical value of ultrasound in the diagnosis of epithelioid sarcoma of limb. Methods 43 patients with epithelioid sarcoma confirmed by surgery and pathology were collected.The characteristics of ultrasound images were compared with the surgical results. And follow up on their short-term recurrence status. Results The ultrasonography of 43 cases of limb epithelioid sarcoma clearly indicated the location of the lesion, and the localization accuracy was 100%. The ultrasonographic manifestations were all lumpy hypoechoic, all without envelope, with an average maximum diameter of (5.73±4.99) cm, mainly solid (81.4%), unclear boundary (55.8%), irregular shape (88.4%), uneven internal echo (95.3%), mostly single lesions(72.1%), and blood flow grading grade III (53.5%). Ultrasound clearly indicated soft tissue mass in 42 cases, and the tumor sensation was not obvious in another case. Ultrasound indicated neuropathy and cicatricial adhesion. After 3 months to 8 years of postoperative follow-up, 22 patients with recurrence and re-operation were directly indicated by ultrasound, and ultrasonography showed uneven solid hypoecho, unclear boundary (15/22), irregular shape (16/22), and Alder blood flow grading was grade I. Conclusion Ultrasound examination of limb epithelioid sarcoma often presents as a single, irregular, solid hypoechoic mass with no capsule, unclear boundaries, uneven internal echoes, and abundant blood flow. Ultrasound can not only clarify the extent of the lesion and its surrounding tissue involvement before surgery, but also provide dynamic follow-up after surgery, which has important clinical value.