Objective      To summarize the chest CT features of severe adenovirus pneumonia in 56 children in order to enhance the diagnostic ability.       Methods      The clinical and chest CT manifestations of 56 children with diagnosed severe adenovirus pneumonia who were admitted in our hospital from April 2010 to April 2011 were retrospectively analyzed.       Results      The immunofluorescence results showed that the exfoliated nasopharyngeal cells from the 56 children were all adenovirus antigen positive. All the children reached the diagnostic criteria of severe adenovirus pneumonia in the program for the control of acute respiratory infections by WHO. The chest CT manifestations showed that lung consolidation was observed in all the patients

including bilateral involvement in 45 patients

consolidation centripetal distribution in 28 patients

clustered consolidation in 43 patients

pleural lesions in 28 patients

lymph node enlargement in 16 patients

pneumothorax in 2 patients and mediastinal emphysema in 2 patients. Small airway changes were observed in 40 patients during the treatment or follow-up.       Conclusion      Multiple clustered consolidation

which can be accompanied by pleural lesions

pneumothorax and mediastinal emphysema

is the main manifestation of severe adenovirus pneumonia in children. Doctors should be vigilant against Bronchiolitis obliterans when small airway changes are observed.