Objective  To evaluate the value of imaging in diagnosing early congenital syphilis.

  Methods  The clinical and imaging data of children with serum tests positive for early congenital syphilis were retrospectively analyzed.

  Results  Out of 43 children, 24 males and 19 females were included in the study. The clinical lesions involved multiple systems and organs, with skin lesions29 cases (67.4%) being the most common. All forty-three children had imaging changes, mainly involving the long bones of the limbs, and the affected parts were mostly symmetrical, including 42 cases (97.7%) involving in the femur, 39 cases (90.7%) in the tibia and fibula, 16 cases (37.2%) of the humerus, 15 cases (34.9%) in radius and ulna. The main manifestation of bone damage was metaphysitis in 35 cases (81.4%), including 24 cases (55.8%)revealing typical "sandwich cake" sign, 11 cases (25.6%) with Wimberger sign, 23 cases (53.5%) with periostitis, and 8 cases of osteomyelitis (18.6%).

  Conclusion  Children with early congenital syphilis have typical imaging findings, and imaging can assist early clinical diagnosis thereby improving prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) are more sensitive, clear and intuitive than X-rays.