Pulmonary cornu is a pulmonary cornu-like nodular change, mostly detected by imaging CT, commonly seen in type II pulmonary tuberculosis also known as hematogenous disseminated pulmonary tuberculosis. The imaging features of this type of pulmonary tuberculosis are mainly multiple cornu-like changes in both lungs, with relatively uniform size, density and distribution. In case of subacute type II tuberculosis, it can show uneven size, density, and distribution, as well as pulmonary cornular changes, which are also seen in silicosis-like changes. Masons and coal miners who are engaged in long-term dust operations in stage I and stage II silicosis can show cornular nodules in both lungs with more speckled distribution. Clinical imaging reveals cornular changes in the lungs, and it is necessary to ask about occupational history and whether the patient has symptoms of tuberculosis toxicity such as recurrent fever, dry cough, little sputum, and body wasting for further targeted treatment.