Methods: This was a retrospective study of ultrasound features, in particular Doppler, in cases with a gray-scale ultrasound diagnosis of ACUM and known final histopathology, in two ultrasound centres in India.The images and video clips were reviewed by two operators and a consensus reached. Results:The study included 15 cases.The wheel-beside-wheel pattern of vascularity was seen in 14 cases of histopathologically confirmed ACUM.One case with gray-scale features of ACUM, showed instead a feeder vessel arising from the arcuate vessels and approaching the lesion.This turned out to be a fibroid with myxoid degeneration.Conclusions: There was a significant correlation between presence of this novel ultrasound vascular pattern 'Wheel-beside-Wheel' and ACUM.This is in line with the present understanding of ACUM being a 'uterus-like mass' within the uterus, with it having its own vasculature similar to the arcuate vessels of the uterus.Particular attention to this distinctive pattern may enhance diagnostic accuracy, obviate need for further imaging, and result in appropriate management.