The application of X-rays for TB is the earliest and most basic test. Chest X-rays can detect early, mild TB lesions. In adults, tuberculosis mostly occurs in the upper lung apices, and depending on the classification of tuberculosis, the X-ray chest radiographs may show different manifestations. Primary tuberculosis shows a dumbbell-shaped lesion and enlarged hilar lymph nodes on X-ray. In the acute stage of hematogenous tuberculosis, X-rays show corn-like nodules of uniform size, density and distribution throughout the lung tissue, with a nodule diameter of about 2 mm. In the subacute and chronic stages of disseminated pulmonary tuberculosis, X-rays show corn-like and nodular shadows of varying size, density and distribution in both upper and middle lung fields, with new and old and calcified lesions coexisting. Secondary pulmonary tuberculosis may show infiltrative pulmonary tuberculosis with small patchy or mottled shadows on imaging, which may be cavernous. In contrast, cavitary pulmonary tuberculosis shows variable morphology on X-rays, with some showing worm-like cavities with inconspicuous walls and fresh, thin-walled cavities accompanied by surrounding regional lesions. Other tuberculosis forms spheroidal lesions, i.e., tuberculosis spheres with calcification or liquefied necrosis within the tuberculosis spheres to form cavities, and most tuberculosis spheres have satellite foci. Some pulmonary tuberculosis may develop secondary inflammatory changes such as caseous pneumonia, with large lobar X-rays, uniformly dense glassy changes, gradual lysis areas, worm-like cavities, and disseminated foci; small lobar X-rays show small lobar patchy disseminated foci, with lesions mostly appearing in the lower and middle parts of both lungs. With the prolonged course of tuberculosis, fibrous cavernous tuberculosis may develop. Due to the repeated prolongation of the disease, lung tissue and function are damaged, and fibrous thick-walled cavities and extensive fibrous hyperplasia appear bilaterally or unilaterally, resulting in elevated hilum and weeping lung texture, contraction of the affected lung tissue, mediastinal displacement to the affected side, and common pleural adhesion and compensatory emphysema. Tuberculosis may also be accompanied by pleurisy and tuberculous pustular chest changes.