Objective To improve diagnosis and differential diagnosis through analyzing the CT characteristics of aspergillosis and pulmonary tuberculosis presenting with bilateral pulmonary multiple cavity. Methods 557 cases of patients with bilateral pulmonary multiple cavities were selected, in which 36 cases were pulmonary tuberculosis and 21 cases were pulmonary aspergillosis. Analyze the CT signs by comparing the distribution of cavities as well as occurrence difference of halo sign, air crescent sign, mycelia in cavities, eccentric cavity, worm-eaten cavity, drainage bronchus and satellite lesions in two groups to carry out statistic analysis, furthermore, compare and analyze pulmonary accompanying radiological performances and lesion dynamic changes between two groups. Results there were differences in distribution, shape, accompanying radiological performances and lesion dynamic changes of pulmonary multiple cavities between two groups. χ2 test was carried out in analyzing occurrence rate of signs relevant to cavity shape, the result had significant difference (P<0.05), main characteristics of pulmonary aspergillosis cavity were halo sign, air crescent sign, mycelia in cavities, with pulmonary aspergillums infection and rapid lesion changes; main characteristics of pulmonary tuberculosis cavity were main locating in superior lobe apicoposterior segment and lower lobe dorsal segment of bilateral lungs, eccentric cavity, worm-eaten cavity, drainage bronchus and satellite lesions, with pulmonary tuberculosis infection and slow lesion changes. Conclusion CT inspection contributes to differentiate aspergillosis and pulmonary tuberculosis presenting with bilateral pulmonary multiple cavities, therefore, it was of great importance in clinical application value.