Objective To discuss the relationship between the MSCT and MRI manifestations and the clinical pathology of parotid gland adenolymphoma. Methods Retrospective analysis has been carried out on the MSCT and MRI manifestations and clinical pathology of 48 patients who are pathologically diagnosed with parotid gland adenolymphoma. Results Among the 48 patients with parotid gland adenolymphoma, 42 of them were with single focus and the other 6 were with multiple focuses. The proportion of patients with lump behind and underneath the superficial lobe of parotid gland was 44/54 (81.48%). Among them, 6 patients also had lesion on the deep lobe; the portion of lump with clear edge was 52/54 (96.30%), with the MRI capsule manifestations of low signal on T1WI and T2WI rims; the proportion of patients with the long axis of lump parallel with underjaw ascending limb is 40/54 (74.07%). For all 48 cases, MSCT and MRI plain scan have been carried out. 15 of them had MSCT enhancement scan; 16 of them had MRI enhancement scan. The MSCT and MRI plain scan results showed lumps with solid or nonhomogeneous density (signal). The parenchyma parts in enhancement scans were mostly obviously intensified. The cystic portions were not intensified or showed lesions with spots, fissures, piebald, or leopard with relatively low density(signal). 18 cases showed enlarged lymph nodes around the lumps. In terms of clinical features, 43/48(89.58%) of the patients have history of smoking. Among the 48 patients, 44 were male and 4 were female. 37/48(77.08%) were aged over 50. In terms of pathological features, the lumps have complete capsules. Cyst cavity could be seen from the section. The cyst cavity under the scope were lined by characterized acidophilic bistratified epithelial cells. The epithelium was in the papillary form and the interstitial substance was lymphocytes. 22 of the submitted samples of peripheral lymph nodes showed reactive hyperplasia. Conclusion There are certain features in the MSCT and MRI manifestations of parotid gland adenolymphoma patients, which is in accordance with its pathological features. These are manifested in the completeness of lump capsules and internal cystic lesions. In addition, if we consider the factors related to middle-aged and senior males and analyze their history of smoking, the accuracy of diagnosis can be improved.