To summarize the ultrasound images and clinical features of aggressive fibromatosis of the abdominal wall, and to improve the understanding of the disease by clinicians and sonographers.

The ultrasound images of 10 patients with aggressive fibromatosis of the abdominal wall diagnosed by pathology in Peking Union Medical College Hospital from January 2018 to November 2025 were retrospectively analyzed, and the characteristics of ultrasound images were summarized.

The ages of the 10 patients with aggressive fibromatosis of the abdominal wall ranged from 29 to 64 years (median age 34.5 years), including 9 female patients and 1 male patient. All 10 patients had single lesions and all occurred in the muscular layer of the abdominal wall. The ultrasound manifestations were mainly hypoechoic (10/10 cases, 100%), parallel growth along the muscular layer (10/10 cases, 100%), infiltrative growth along the horizontal direction of the muscular layer (7/10 cases, 70%), clear lesion boundaries in the direction perpendicular to the muscular layer (10/10 cases, 100%), and uneven internal echoes (9/10 cases, 90%). No calcification or liquid dark areas were observed internally (10/10 cases, 100%).

Aggressive fibromatosis of the abdominal wall has certain characteristics on ultrasound images. Sonographers should combine clinical manifestations and ultrasound characteristics to distinguish it from other masses of the abdominal wall.