The probability of misdiagnosis of tuberculosis on CT is very high because tuberculosis mainly presents with polymorphic changes, such as proliferation, exudation, nodules, calcification, cavities, pleural thickening, and pleural effusion, which need to be differentiated from many diseases. For example, pleural effusion needs to be differentiated from cancerous pleural effusion, lung cavity needs to be differentiated from cancerous cavity and lung abscess cavity, and nodules and proliferation need to be differentiated from chronic lung infection and whether there is a combination of silicosis. If it is a lung nodule change, enhanced CT examination is needed to understand whether it is a possible lung cancer. In conclusion, clinical examination of pulmonary tuberculosis by CT alone has a high probability of misdiagnosis. It is necessary to combine the patient’s sputum check for antacid bacilli, tuberculosis antibody test as well as T-cell test for tuberculosis infection and tumor marker test and other comprehensive means to clarify the diagnosis as early as possible to avoid misdiagnosis and missed diagnosis.