Objective <p>This study aimed to preliminarily characterize the ultrasonographic features of pediatric pleuropulmonary blastoma (PPB). With surgical–pathological findings serving as the gold standard, the imaging manifestations of thoracic ultrasound (US) and computed tomography (CT) in PPB were compared, and correlations between ultrasonic and pathological characteristics of this rare pediatric malignancy were explored. The diagnostic consistency and complementary value of the two imaging modalities were further evaluated, their clinical application scopes were clarified, and the potential value of thoracic US in the imaging evaluation of PPB was assessed, This study provided a preliminary reference for the optimization of clinical diagnostic strategies for PPB.</p> Methods <p>A retrospective analysis was performed on the clinical data of 12 pediatric patients with surgically–pathologically confirmed PPB who underwent preoperative thoracic US and CT at the Children’s Hospital Affiliated to Shandong University between October 2017 and November 2024. The sonographic and CT imaging manifestations of the lesions were summarized and documented in accordance with unified diagnostic criteria. The diagnostic consistency and differences between the two imaging modalities were further explored. A standardized ultrasound–pathology double-blind design was adopted to observe the correspondence between ultrasonic features and pathological findings.</p> Results <p>Among the 12 pediatric patients with PPB, thoracic US identified intrathoracic masses (12/12), atelectasis (10/12), pleural effusion (11/12), and pleural thickening (5/12), while CT detected intrathoracic masses (12/12), atelectasis (11/12), pleural effusion (11/12), and pleural thickening (6/12). No substantial difference was found between the two modalities for these findings. In this study cohort, the two modalities exhibited potential complementary strengths for PPB lesion assessment: CT tended to show relative advantages in detecting pneumatocele, microbubble-containing pneumothorax lesions involving tracheal carina and main bronchi, deep mediastinal invasion, and supradiaphragmatic lymph node metastasis; which are less optimally visualized by US. In comparison, US appeared to offer clearer delineation of pericardial effusion, tumor invasion into the left cardiac cavity, tumor attachment site, and its anatomical relationship with cardiac valve structures. A certain correlation was observed between the ultrasonic manifestations of PPB and its pathological features. Follow-up confirmed that US was suitable for repeated dynamic monitoring during long-term clinical follow-up.</p> Conclusion <p>Thoracic US can act as a feasible imaging modality for initial screening, dynamic monitoring and long-term postoperative follow-up of pediatric PPB. Combined US and CT may partially compensate for the limitations of single-modality imaging and provide complementary diagnostic value, potentially improving overall evaluation accuracy. Proper use of thoracic US may reduce unnecessary radiation exposure in children and provide reliable imaging evidence for individualized clinical diagnosis and management. Pathological examination is regarded as the reference standard for the definitive diagnosis of pediatric PPB.</p>