[The diagnosis of smear negative pulmonary tuberculosis in superior segment of lower lobe]

20 cases of tuberculosis in the superior segment of the lower lobe of the lung were misdiagnosed as lung cancer, pneumonia, bronchiectasis and inflammatory pseudoneoplasm were reported. The final diagnosis were confirmed by fiberoptic bronchoscopy (FOB). The causes of the misdiagnoses were: (1) the hilar mass shadow found on the PA chest film, mistaken for central type lung cancer; (2) the mass shadow found on the lateral chest film, mistaken for peripheral lung cancer; (3) the patients with fever, cough and expectoration accompanied by exudative infiltrative shadow, mistaken for pneumonia; (4) patients with recurrent attacks of hemoptysis but the lesions overshadowed by the spinal column on the lateral chest film were misdiagnosed as bronchiectasis. The author suggested PA and lateral chest films taken simultaneously were needed. The special points, to which should be pay attention during reading the films were listed and noted. FOB examination including TBLB, brushing and BALF for pathologic and AFB determination could be of help to confirm the diagnosis.