Background: This study aimed to explore the clinical characteristics and management of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children and gain a better understanding of the diagnosis treatment and prognosis of the disease. Methods: We retrospectively reviewed the medical records of 16 children who were diag-nosed with MPP associated with PE and NP between Janunary 2016 and Janunary 2023 at Children’s Hospital, Zhejiang University School of Medicine. Results: All of the cases were diagnosed with refractory mycoplasma pneumoniae pneum-onia (RMPP) and complicated with necrotizing pneumonia(NP). The ages of the patients ranged from 5.3 to 11.5 years old. The main manifestations were cough and fever（n=16, 100%）,chest pain (n=8, 50%) , shortness of breath(n=8,50%), hemoptysis (n=4, 25%). Among them, the pulmonary artery was involved in 12 patients, including 6 cases on the right, 4 cases on the left, and 2 cases on both sides. Besides, the pulmonary vein was suffered in 3 patients. Furthermore, Pulmonary artery and pulmonary vein were involved in 1 patient. The mean D-dimer level was 8.50±4.76mg/L. All patients underwent anticoagulant therapy. After treatment, all patients ’s symptoms were improved, and the lung lesions were significantly improved. Conclusion: For children with RMPP, PE and NP should be considered when chest pain, hemoptysis or high level of d-dimer are present. Chest enhanced CT scan should be perf-ormed as soon as possible, and anticoagulation should be treated once the diagnosis of PEis confirmed. The long-term prognosis of PE was favorable after the timely administrationof anticoagulant therapy.