Objective To explore the image characteristics of pseudo-lipomatous tumor paraesophageal (PLTP). Methods A total of 18 cases of PLTP were collected, of which 8 were examined by GI(Upper gastrointestinal barium contrast medium) and MSCT simultaneously, the comparative analysis of GI and MSCT was performed. Results There were 5 cases GI showed the soft tissue shadow on the right side of the lower esophagus, with lower dentist and esophageal mucous disorder at mucous phase, was showed coarse disorderly in the mucous membrane phase. Filling phase showed a slightly narrow esophageal cavity, with soft wall, no displacement and visible upper boundary. 3 case with obtuse His angle, Of which one case its change with position. 3 cases with almost normal GI manifestion, 1 case of sliding hiatal hernia the stomach protruded into PLTP. A cystic fat density shadow was showed by MSCT right paraesophagus above hiatus in18 cases.The connection of the lower part of cystic fat density shadow to abdominal fat was showed all in 18 cases by MPR, and left gastric artery was shown to point to or protrud into hiatus by arcuate or straight form. Conclusion A larger fade soft tissue density shadow above the hiatus paraesophageal, with slight change of mucous membrane and lumen of lower segment esophagus which no obviously shifted and with His angle obtuse variable were the characteristic GI performance of PLTP. The fat capsulethe connected with abdominal fat with left gastric artery shown to point to or protrud into hiatus by arcuate or straight form was the image characteristics of MSCT.