73歲李姓婦人因流感病毒病肺炎，出現發燒及呼吸困難， X光片呈現左肺浸潤，治療後，左肺浸潤消失，卻另發現左肺門有腫塊，懷疑為肺癌，進一步培養發現是結核分枝桿菌作怪，經 6個月的抗結核病治療後，氣喘明顯改善，左側肺門腫瘤也已消失。
郭綜合醫院胸內科主任謝武峰指出，結核病的臨床表現千變萬化，初發病時往往沒有明顯或特異性的症狀，且症狀過程緩慢，時好時壞，甚至於侵犯的器官不限於肺部，而使得診斷更加困難。所以要診斷結核病必須綜合臨床表現，加上放射線學變化，最後再以實驗室檢驗加以證實，才算完整。
除了李姓婦人的例子外，也有一名 60歲男性出現呼吸困難、食慾不振，且長期腹瀉，來到急診就醫時非常虛弱且骨瘦如材，體重只有 38公斤，當時 X光片呈現為瀰漫性栗粒肺病變，懷疑為栗粒肺結核，但是病人無法自咳，所以接受支氣管鏡檢查，其支氣管檢查肺灌洗液，肺結核聚合 ?鏈鎖反應為陽性；因長期腹瀉也做了糞便查，結果肺結核聚合 ?鏈鎖反應為陽性。證實病人為肺結核跟消化道結核，接受 9個月的抗結核病治療，症狀改善並體重上升為 54公斤，持續追蹤 X光片，肺病變也消失了。
謝武峰說， X光檢查在肺結核的診斷上有極重要的角色，但由於肺結核影像變化的多樣性，因此，在肺結核的診斷上仍有其限制。特別是老年人伴隨多種慢性疾病時，常導致較常見的胸部 X光影像表現，如中、下肺葉的浸潤病灶、肺炎般的病灶而需與肺炎進行鑑別診斷，或如腫瘤般的影像而需與肺癌進行鑑別診斷等。
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A 73-year-old woman named Li was suffering from fever and breathing difficulties due to influenza virus pneumonia. X-ray film showed left lung infiltration. After treatment, left lung infiltration disappeared, but another left mass was found in the lung. It was suspected to be lung cancer. Further culture was found to be tuberculosis. Bacteria, after 6 months of anti-tuberculosis treatment, asthma significantly improved, the left hilar tumor has also disappeared.
Xie Wufeng, director of the Department of Thoracic Medicine of Guo General Hospital, pointed out that the clinical manifestations of tuberculosis are ever-changing. There are often no obvious or specific symptoms at the initial onset, and the symptoms are slow, good or bad, and even the organs that are invaded are not limited to the lungs, which makes the diagnosis. more difficult. Therefore, to diagnose tuberculosis must be combined with clinical manifestations, plus radiological changes, and finally confirmed by laboratory tests, it is complete.
In addition to the example of a woman named Li, there is also a 60-year-old man who has difficulty breathing, loss of appetite, and long-term diarrhea. When he came to the emergency department, he was very weak and skinny, weighing only 38 kilograms. At that time, the X-ray film was diffuse. Chestnut lung disease, suspected as chestnut tuberculosis, but the patient can not self-cough, so bronchoscopy, bronchial examination of lung lavage fluid, tuberculosis polymerization? Chain reaction is positive; due to long-term diarrhea also done stool examination, Results The tuberculosis polymerization was positive for the chain reaction. The patient was confirmed to have tuberculosis and gastrointestinal tuberculosis, received 9 months of anti-tuberculosis treatment, improved symptoms and gained 54 kg, continued to follow X-rays, and lung lesions disappeared.
Xie Wufeng said that X-ray examination has a very important role in the diagnosis of tuberculosis, but due to the diversity of image changes in tuberculosis, there are still limitations in the diagnosis of tuberculosis. Especially in the elderly with a variety of chronic diseases, often lead to more common chest X-ray imagery, such as invasive lesions of the middle and lower lobe, pneumonia-like lesions need to be differentiated from pneumonia, or as a tumor-like image Differential diagnosis with lung cancer.
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