Objective To explore the clinical and imaging features of primary plastic bronchitis in children. Methods A retrospective analysis was performed on 27 children with primary plastic bronchitis diagnosed in the hospital during the period from January 2015 to December 2017. The general data, clinical symptoms, laboratory examination results, features of fiberoptic bronchoscopy and CT images were statistically analyzed. The clinical and imaging features of primary bronchitis were summarized and analyzed. Results All patients had different degrees of symptoms such as cough, high fever, shortness of breath and progressive dyspnea. There were 7 cases with Staphylococcus aureus infection, 19 cases with Mycoplasma pneumoniae infection, 5 cases with positive adenovirus antigen, 2 cases with Candida albicans infection and 8 cases with mixed infection. Blood routine and serum biochemical tests mainly showed elevated white blood cell count and increased erythrocyte sedimentation rate (ESR). Plastic mucus plugs showed fibrinoid changes under pathological microscope, showing large number of neutrophils and lymphocytes and other inflammatory cell infiltration. Chest CT showed lung infection, lung consolidation signs, partial or complete obstruction of the bronchus, segmental pulmonary atelectasis in 5 cases, pleural effusion in 9 cases, parcel pneumothorax in 2 cases, bronchial mucous impaction in 10 cases and pleural lesions in 4 cases. Plastic mucus plugs in all children were removed under bronchofiberscope and the bronchus was rinsed repeatedly. The respiratory function of children was significantly restored after sputum-removal, anti-infection and immune supportive therapies, and the condition was significantly improved. Conclusion For children with suspected primary plastic bronchitis, chest CT and pathological examination should be used for diagnosis in time. Supportive symptomatic treatment combined with early removal of endogenous foreign body under bronchofiberscope can relieve respiratory obstruction and reduce the risk of death.