The health management of the reciprocating compressor is crucial for its long term steady operation and safety. Online condition monitoring technology for the reciprocating compressor is almost mature, whereas the fault diagnosis technologies are still insufficient to meet the need. Therefore, in this paper, a novel fault detection method for the reciprocating compressor based on digital image processing and artificial neural network (ANN) was proposed. This method is implemented to the sectionalized pressure–volume (p–V) curves, which are obtained by dividing a working cycle in the cylinder into four thermal processes, including expansion, suction, compression and discharge. Hit-or-miss transform is adopted to extract the comprehensive gradients of expansion and compression curves, and vertical projection transform is applied to extract the vertical projection features. Finally, all of the features are fed to an ANN to do classification. To validate the proposed method, a seeded fault testing was conducted to collect real running data. The results showed that the new approach shows a good performance, with a high classification accuracy of 97.9%.