Objective To investigate the clinical imaging features and efficacy of pleural tuberculoma (PTM) in children, and to improve the understanding of this disease.Methods The clinical date of 36 children diagnosed with PTM were retrospectively analyzed.Results Among the 36 patients (24 boys and 12 girls), 26 were from rural areas and 10 were from urban areas, and the median age was 10.0 (7.3-13.8) years. Four children were 0-5 years old, 11 were 5-10 years old, 12 were 10-14 years old, and 9 were >14 years old. All the children had a clear history of tuberculous pleurisy. Chest CT scans showed typical manifestations of PTM, including single lesions in 30 cases and multiple lesions in 6 cases. The lesions were located on the right side in 22 cases, on the left side in 12 cases, and on both sides in 2 cases. Isoniazid combined with rifampicin and pyrazinamide were used as the main anti-tuberculosis regimen. PTM was found in 24 patients less than 3 months after anti-tuberculosis treatment, 9 patients between 3 and 6 months after treatment, and 3 patients after 6 months of treatment. After the diagnosis of PTM, 25 children were treated with the original regimen, 4 were treated with linezolid and 3 with ethambutol in combination, and 4 were treated with surgery. Finally, 34 children were cured and 2 were under treatment.Conclusions Children's PTM mostly occurs in older boys with tuberculous pleurisy within 3 months of anti-tuberculosis treatment. Chest CT is helpful for diagnosis, and most of the children can be cured by medical treatment.