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Objective: To explore the value of echocardiography in the diagnosis and follow-up of cardiac thrombosis in children with Mycoplasma pneumoniae pneumonia. Methods: This was a case series analysis. Children diagnosed with Mycoplasma pneumoniae pneumonia combined with cardiac thrombosis at the Children's Hospital of Shandong University from November 2015 to December 2023 were enrolled. Echocardiographic findings were collected, with emphasis on sonographic characteristics of cardiac thrombi, changes in thrombus size after treatment, and thrombus resolution. Results: A total of 22 children (15 males; aged 6.2±2.2 years) were included. Echocardiography showed right ventricular thrombi in 20 cases (91%), including 19 in the right ventricular inflow tract and 1 in the right ventricular outflow tract; a thrombus in the main pulmonary artery in 1 case (5%); and a thrombus in the proximal left inferior pulmonary vein in 1 case (5%). Among the 22 patients, 1 (5%) underwent surgical thrombectomy, and the remaining received anticoagulation therapy. During the 12-month follow-up, 1 patient receiving anticoagulation was lost to follow-up; in the remaining 20 patients, thrombi gradually decreased in size, and disappeared completely in 17 cases. Conclusions: In children with Mycoplasma pneumoniae infection complicated by cardiac thrombosis, echocardiography can clearly delineate thrombus location, size, and post-treatment changes. It is the preferred imaging modality for diagnosing cardiac thrombosis associated with Mycoplasma pneumoniae infection.