Objective To analyze the manifestations of chest X-ray and CT in children with severe hand-foot-mouth disease (HFMD). Methods The clinical data of 47 cases of children with severe HFMD in our hospital from June 2015 to January 2017 were collected. All children were given the chest X-ray examination, and 15 cases were given the chest CT plain scan. Results There were different manifestations of chest imaging in 47 cases of children. The form was as follows: there were 6 cases with the type of lung interstitial involvement bronchitis, 8 cases of localized type confined to a single lobe or lung, 19 cases with mixed type lesions involving multiple lobes or even the whole side lung, 11 cases with the extensive type involving a double multiple lung lobes and 3 cases with the pulmonary edema type with pulmonary double symmetrical patchy shadows and gradually faded density from the inside to the outside. With the change of the condition of severe HFMD children, the chest X-ray changed, and the recurrence could be seen in some children. Conclusion Chest X-ray and CT have many manifestations in severe HFMD children, mainly with flocculent shadow and accompanied by other manifestations of lung, and they show dynamic changes and certain features with the disease.