Objective To investigate the diagnostic value of multi-slice spiral CT (MSCT)and transthoracic echocardiography (TTE) for coronary aneurysms in Kawasaki disease (KD). Methods 86 children with KD coronary aneurysms who were treated in our hospital were selected as subjects. The clinical data of all children were retrospectively analyzed. The pathological examination was used as the standard to compare the diagnostic accuracy, sensitivity, and specificity of different examination for KD coronary aneurysms and to analyze the imaging manifestations of KD coronary aneurysms in different examination methods. Results 154 lesions of coronary artery were detected in 86 children. Thedetection rate of lesions by MSCT was 97.40% (150/154), and the diagnostic coincidence rate was 95.35% (82/86). The detection rate of lesions by TTE was 92.21% (142/154), the diagnostic coincidence rate was 88.37% (76/86).There was no difference in the detection rate and coincidence rate for lesions of KD coronary aneurysm between the two methods (P>0.05). Conclusion The MSCT and TTE examinations have consistent detection rates and diagnosis rate for KG coronary aneurysms, and the image is similar.However, the MSCT image is clearer and it is less affected by relevant factors.Therefore, it can be combined to make up for the deficiency of TTE, further improve the diagnostic accuracy of KD coronary aneurysm, and provide further guidance for clinical treatment.