目的:探讨重症小儿支原体肺炎X线影像学表现。方法:回顾性分析近5年期间临床住院确诊的重症支原体肺炎22例首诊胸部X线表现。结果:10例表现为两肺门影增浓,肺纹理增多,可见网状改变,以双侧肺野为主,4例可见右侧中下野内中带云雾状模糊影,5例表现为左心后区小斑片状影,2例可见右上肺不张,1例右肺中叶不张,其中8例分别可见少量胸腔积液,22例均未见肺大泡,气胸及明显肺气肿改变。结论:儿童重症支原体肺炎X线胸片表现多样,兼有间质性肺炎,及支原体肺炎影像改变,容易合并胸膜反应及肺不张改变,肺大泡,肺气肿及气胸等并发症少见. Objective: To investigate the X-ray findings of severe mycoplasma pneumonia in children. Methods: The chest X - ray findings of 22 cases of first diagnosis of severe mycoplasma pneumonia confirmed by clinical inpatients during the recent 5 years were retrospectively analyzed. Results: In 10 cases, the thickening of the lungs and the enhancement of the lung texture were observed. The reticular changes were observed in both lung fields. Four cases showed a cloud-like blur in the middle and lower right middle part of the right middle part. Small patchy shadow in the posterior region of the heart, 2 cases of right upper lung atelectasis, 1 case of right middle lobe atelectasis, 8 cases were seen a small amount of pleural effusion, 22 cases were no bullae, pneumothorax and significant emphysema change. Conclusion: The manifestations of severe mycoplasma pneumonia in children with chest X-ray are diverse, with both interstitial pneumonia and mycoplasma pneumonia. It is easy to be combined with pleural reaction and atelectasis. The complications such as bullae, emphysema and pneumothorax are rare.