To reduce the speckle noise and preserve the edge information, a novel algorithm based on an adaptive total variation method is proposed. The smoothing process uses adaptive windows whose shapes, sizes and orientations vary with image structures. Adaptive window calculate instantaneous Lagrange coefficient for edge areas with more accuracy avoiding smoothing these regions and performing well in large ones. Experimental results show that, the performance of the proposed method is satisfactory in terms of both speckle suppression and preservation of medical ultrasound image details.