Objective To analyze the clinical features and CT imaging of silicosis with pulmonary tuberculosis in 16 cases. Methods Sixteen patients with silicosis and pulmonary tuberculosis who were admitted to the hospital between June 2014 and December 2016 were enrolled in the study. Their clinical features and imaging findings were analyzed. The diagnostic accuracy and pathological characteristics were compared between chest X-ray and CT. Results The main manifestations of silicosis and pulmonary tuberculosis include chest distress (75.00%), cough (56.25%), shortness of breath (43.75%) and chest pain (50.00%). Some patients had night sweat, low-grade fever and depression. Chest X-ray showed small shadow changes, massive shadow, inhomogeneous density, clear edges and no emphysema. CT showed punctate calcification, old combined lesions and diffuse lung fibrosis in bilateral lungs. The lesions were mainly located around the vascular bundle. The accuracy of CT in the diagnosis of silicosis and pulmonary tuberculosis was significantly higher than that of X-ray (P＜0.05). The detection rates of CT for small nodules, calcified tuberculosis and emphysema were significantly higher than those of X-ray (P ＜0.05). Conclusion The main symptoms of silicosis and pulmonary tuberculosis include chest tightness, cough, shortness of breath, chest pain, night sweats, low-grade fever and depression. CT shows typical imaging findings and it is worthy of clinical application.