Objective To investigate the diagnostic value of multi-slice spiral CT (MSCT) in differential diagnosis of tracheobronchial foreign bodies in children. Methods A total of 296 cases of primary airway foreign bodies in our hospital were selected from January 2015 to February 2017. The results of preoperative chest X and MSCT examination were analyzed retrospectively. The MSCT imaging features of children's airway foreign bodies were analyzed, and the clinical value of the diagnosis of MSCT in the diagnosis of children's airway foreign body by surgical diagnosis was analyzed. Results The rigid bronchoscopy confirmed 222 cases of children with airway foreign body, foreign body type is mainly plant (84.68%). 222 cases of distribution of airway foreign bodies in Table 2, mainly distributed in the left and right trachea trachea (52.70%) (39.64%); X-ray diagnosis of airway foreign bodies in 117 cases, the main manifestations of emphysema (43.24% MSCT), diagnosis of airway foreign bodies in 209 cases, mainly for emphysema (62.61%), local obstructive (55.86%) and mediastinal shift (39.19%), the sensitivity of X-ray diagnosis of airway foreign body was 44.14%, the specificity was 74.32%, the misdiagnosis rate was 55.86%, the misdiagnosis rate was 25.68%; the sensitivity of MSCT for the diagnosis of airway foreign body 90.99%, the specificity was 90.54%, the misdiagnosis rate was 9.01%, the misdiagnosis rate was 9.46%. Conclusion MSCT has high sensitivity and specificity in the differential diagnosis of tracheal foreign bodies in children, and has important value for the definite diagnosis before operation.