Abstract: Paragonimiasis (PG) is a natural focal zoonotic disease caused by the ingestion of metacercariae. Children and adolescents account for 88% of cases. It is endemic in Sichuan, Yunnan, Chongqing, and other regions. With changes in dietary habits, the occurrence rate in urban areas has gradually increased. PG is classified into pleuropulmonary, abdominal, subcutaneous nodular, and cerebrospinal types based on the site of parasite localization. Definitive diagnosis relies on parasitological evidence, but the detection rate is low. Consequently, imaging examinations have become crucial for early identification, localization of ectopic infections, and assessment of complications. This review summarizes the imaging manifestations of PG in children, aiming to improve diagnostic efficiency and reduce misdiagnosis among healthcare professionals. Key findings include the following: thoracic/pulmonary PG is characterized by the “tunnel sign” on CT scans, accompanied by pleural effusion or mediastinal involvement; abdominal PG presents with the “tunnel sign” or “mushroom sign” in the liver; subcutaneous nodular PG manifests as soft tissue masses; and central nervous system PG may present with the “tunnel sign” within the brain parenchyma or hemorrhage. Imaging techniques such as CT, MRI, and ultrasound can effectively assess the extent of lesions, with the “tunnel sign” being a typical feature of PG. When combined with epidemiological history and peripheral blood eosinophil counts, these findings can significantly improve diagnostic accuracy. Imaging plays a central role in the comprehensive management of PG in children.