Among 42 child cases of pulmonary echinococcosis granulosus treated by excision of internal cyst through video-assisted thoracoscopic surgery (VATS), the cysts were completely removed in 28 cases (66.7%), cysts in 14 cases (33.3%) were removed by puncture, and cyst ruptured accidentally during operation in 1 cases (2.4%). The mean operation time was (96.70 +/- 10.90) min, mean volume of blood loss during operation was (8.60 +/- 1.31) ml, and the average admission in hospital was (10.20 +/- 1.10) d, with post-operation complications in 2 cases (4.8%). Three years' follow-up revealed no recurrence. The VATS is a way for treating pulmonary echinococcosis granulosus in children with light trauma, less bleeding and fewer complications.