Secondary tuberculosis of both upper lungs is the most common form of tuberculosis, which mainly manifests as cough, sputum, hot flashes, night sweats, even with blood in the sputum and prolonged recurrent fever, and progressive weight loss, mostly in the form of open tuberculosis. Secondary changes in bilateral pulmonary tuberculosis may indicate the formation of exudate, proliferation, nodules, plaques, calcifications and cavities in both upper lungs on chest radiographs. Because secondary pulmonary tuberculosis includes both infiltrative and cavitary tuberculosis, especially in the acute infectious phase, widespread epidemics are likely to occur, and early sputum examination for antacid bacilli is required for early standardized antituberculosis treatment. Secondary tuberculosis in both upper lungs is different from types I, II, IV, and V tuberculosis and falls within the scope of national priority control for tuberculosis treatment. Therefore, once chest imaging suggests secondary tuberculosis in both upper lungs, it is necessary to clarify whether it is infectious as early as possible so that anti-tuberculosis treatment can be standardized early.