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Objective To analyze the clinical manifestations and the imaging mainly CT of metanephric adenoma in chidren. Methods We reviewed the manifestations of clinics and the imaging mainly CT at our institution and reported observations on the diagnosis of metanephric adenoma in children based on these 2 patients and an additional 10 cases from the literature. Results More cases of metanephric adenoma could have polycythemia at presentation. Also in more patiens, US image depicted well-circumscribed hyperechoic mass. Un-enhanced CT scan showed the higher attenuation mass with calcification, some cases had cystic mass with a single solid mural nodule. At contrast-enhanced CT, the degrees of enhancement varied. In our new cases, one showed a large polycystic mass abounded with fat-attenuation material. Conclusion Manifestations of metanephric adenoma varied from each other, we should analyze the clinical manifestations as well as the characteristics of imagings and it would help for diagnosis. But the diagnosis of the tumors must be based on histological examinations.