Objective To explore the sonographic features of accessory abscess and improve the coincidence rate of ultrasonic diagnosis. Methods 104 patients with accessory abscess confirmed by surgery and pathology in our hospital from January 2018 to May 2020 were selected for a retrospective analysis of the preoperative characteristics of transvaginal ultrasonography. The diagnostic value of transvaginal color Doppler ultrasound in pelvic inflammatory diseaseaccessory abscess were evaluated. The causes of misdiagnosis and differential diagnosis were summarized and analyzed.Results Among the104 cases, 86 cases were diagnosed correctly by preoperative ultrasound, with a diagnosis coincidence rate of 82.7%, and 10 cases were misdiagnosed (9.6%). Eight cases were missed (7.7%). Among the 104 patients, 56 had bilateral lesions and 48 had unilateral lesions, with a total of 160 lesions. Among them, there were 95 lesions of pyosalpinx and 65 lesions of tuboovarian abscess(TOA). The 160 lesions were divided into 3 types according to the sonographic features inclcudeing 79 cases of cystic lesions, 52 cases of cystic and solid mixed echogenic lesions and 29 cases of solid lesions.Conclusion Transvaginal color Doppler ultrasonography in the diagnosis of pelvic inflammatory diseaseaccessory abscess is easy and fast to operate. Mastering its sonographic features and differential diagnosis, combining the clinical manifestations and laboratory examination can improve the accuracy of clinical diagnosis.