A new speckle reduction method, i.e., Laplacian pyramid-based nonlinear diffusion (LPND), is proposed for medical ultrasound imaging. With this method, speckle is removed by nonlinear diffusion filtering of bandpass ultrasound images in Laplacian pyramid domain. For nonlinear diffusion in each pyramid layer, a gradient threshold is automatically determined by a variation of median absolute deviation (MAD) estimator. The performance of the proposed LPND method has been compared with that of other speckle reduction methods, including the recently proposed speckle reducing anisotropic diffusion (SRAD) and nonlinear coherent diffusion (NCD). In simulation and phantom studies, an average gain of 1.55 dB and 1.34 dB in contrast-to-noise ratio was obtained compared to SRAD and NCD, respectively. The visual comparison of despeckled in vivo ultrasound images from liver and carotid artery shows that the proposed LPND method could effectively preserve edges and detailed structures while thoroughly suppressing speckle. These preliminary results indicate that the proposed speckle reduction method could improve image quality and the visibility of small structures and fine details in medical ultrasound imaging.