Objective To analyze the features of CT manifestations of patients with ventilator-associated pneumonia (VAP). Methods The clinical cases and CT imaging data of 120 VAP patients in our hospital from January 2017 to February 2018 were analyzed, and the features of CT manifestations, such as lesion distribution, morphology and density were recorded according to the multiplane reconstruction for image processing. Results 95 cases (79.17%) were bilaterally distributed and 78 cases (65.00%) were the symmetrically distributed, and the lower lobe symmetry of double lungs was the most common (46.67%), and obvious high density shadow was seen subpleural area of posterior lower lobe of double lungs. Obvious lower lobe lesions of right lung were observed in 120 cases, and 31 cases (25.83%) were only lower lobe lesions of right lung and the remaining 89 cases were all involved in lower lobe lesions of double lungs [30 cases (25.00%) single lesions were located in the lower lobe of right lung. A total of 264 lesions were performed in 120 patients, of which 253 (95.83%) were located in the dorsal subpleural area. 111 cases (92.50%) were without abnormal lung lesions by CT before tracheal intubation and were with new infiltrative lesions after tracheal intubation, and crescent-like soft tissue density shadow in the dorsal subpleural area were observed in 105 cases (87.50%), and the changes of ground glass opacity were observed in 19 cases (15.83%), and the patch-like infiltration shadow distributed along the lung markings which were similar to CT findings in bronchopneumonia and interstitial pneumonia were observed in 14 cases (11.67%), and air bronchogram signs were observed in 2 cases (1.67%). Conclusion CT manifestations of VAP patients have certain features in the distribution and morphology of lesions, and they can provide imaging basis for the diagnosis of VAP, guide the condition judgment, formulate the treatment plans and select the extubation time.