Background - Pneumonia remains the most important cause of mortality and morbidity in young children globally. Pneumonia can be diagnosed clinically, pathologically, microbiologically and radiologically. Radiological diagnosis has been used in many settings to identify children with pneumonia using chest radiography; nevertheless researches revealed that not all children with pneumonia show radiological changes (i.e. in early stage of the disease or in immune compromised). This research aims at comparing children with radiological pneumonia to those with no radiological pneumonia who undergo chest radiography during or after admission to paediatric ward KCMC. Objective - To determine prevalence and clinical features of children under-five years of age with radiological and no radiological pneumonia admitted at pediatric ward KCMC referral hospital, from January to December 2015. Methodology – This was a retrospective descriptive cross section study involving chat review of all children under-five years of age admitted due to pneumonia at KCMC pediatric ward from January to December 2015.We used a checklist to extract details of children admitted with pneumonia diagnosis followed by recording information including the socio-demographic characteristics such as age and child gender, history, clinical findings including chest x-ray report using a case report form. Data were sorted and coded followed by data entry and analysis, using Statistical Package software STATA version 11. Results - The overall prevalence of radiological pneumonia was 47.6%. Children aged one year and above occupied the highest proportion among children with radiological pneumonia. Cough, fever, lower chest in-drawing and increased respiratory rate for age group 2-11 months were among clinical features significantly associated with radiological pneumonia compared to no radiological pneumonia. Conclusion - Prevalence of radiological pneumonia was high and this is an important public health concern as strategies to reduce pneumonia morbidity and mortality proceed. Given that most of this children are seriously ill, it’s not of surprise however effort should be made to tackle pneumonia at its early stage as effective interventions exists and therefore reducing pneumonia burden is vital for improved child health and survival.