Objective To analyze the CT imaging findings of pulmonary tuberculosis complicated with lung cancer, and provide reference for the diagnosis. Methods Forty patients with pulmonary tuberculosis complicated with lung cancer treated in our hospital between April 2013 and September 2014 were selected as the observation group. Another 40 cases with pulmonary tuberculosis complicated with neoplasms in lung were selected as control group. The clinical manifestations of both groups were observed. Shape, location and the boundary signs of neoplasms in lung were recorded during CT examination, and CT imaging findings of both groups were analyzed and compared. Results The main manifestations of both groups were recurrent cough, blood-stained sputum, chest tightness, shortness of breath, chest pain, emaciation and low-grade fever,etc..There were no specific manifestations in the observation group; The main CT imaging findings in the observation group were lobulation sign, spicule sign, vacuole sign complicated with pulmonary atelectasis, spiculate protuberance, cavity, vascular bundle aggregation sign and pleural indentation, etc. Imaging comparison showed that in CT findings of the observation group,neoplasms accounted for 70.00%, lobulation sign for 60.00%, spiculate nodules for 32.50% and pleural indentation for 75% which were significantly higher than those in the control group (27.50%, 35.00%, 10.00%, 32.50%). The proportion of cavity in the observation group(12.50%) was lower than that in the control group (32.50%) (P<0.05). There was no significant difference in the proportion of stripped shadow between the two groups (5.00%, 12.50%) (P>0.05). Conclusion The main CT imaging findings of pulmonary tuberculosis with lung cancer included lobulation sign, spicule sign, spinous protuberance, vacuole sign complicated with pulmonaryatelectasis, cavity and pleural indentation. Clinical diagnosis of the disease should be performed according to the characteristics and clinical manifestations.