目的：探讨肺巨大结核瘤的Ｘ线和ＣＴ表现以及和肺癌的鉴别。方法：５０例经手术、病理证实的巨大肺结核瘤，直经全部在３ｃｍ以上，全部摄有胸部正侧位Ｘ线片，３１例摄病灶或／和支气管体层，１５例进行了ＣＴ扫描。作者用双盲法分析了其不典型Ｘ线和ＣＴ表现以及与肺癌的鉴别诊断。结果：（１）发生在非好发部位（６０％）；（２）瘤体呈分叶状（３８％）；（３）边缘出现毛刺（２０％）；（４）瘤体与胸壁出现胸膜凹陷征；（５）特殊形态的空洞；（６）纵隔和肺门淋巴结肿大。结论：巨大肺结核瘤诊断比较困难，不容易与肺癌相鉴别，当出现病灶中心钙化。引流支气管和卫星病灶等典型表现能肯定诊断。当结核瘤表现不典型时，如发生于非好发部位、肿块呈分叶形、出现胸膜凹陷征、空洞呈偏心状以及合并肺门纵隔淋巴结肿大时诊断比较困难，往往误诊为周围型肺癌。因此诊断时需要综合分析 Objective: To investigate the X-ray and CT findings of lung huge tuberculoma and the identification of lung cancer. Methods: Fifty cases of giant pulmonary tuberculosis confirmed by operation and pathology were directly surgically treated with 3 cm or more of them. All of them had posterior chest radiographs, 31 cases of lesions and / or bronchial bodies, and CT scan was performed in 15 cases. The authors used double-blind analysis of atypical X-ray and CT findings and the differential diagnosis of lung cancer. Results: (1) occurred in non-predilection sites (60%); (2) tumors lobulated (38%); (3) burr on the edge (20%); Depression sign; (5) Special form of cavity; (6) Mediastinal and hilar lymph nodes. Conclusion: It is difficult to diagnose huge pulmonary tuberculosis and it is not easy to differentiate it from lung cancer. When there is calcification in the center of the lesion. Typical findings such as drainage of bronchi and satellite lesions confirm the diagnosis. When tuberculoma is not typical, such as occurred in non-predilection sites, lobes were lobulated, pleural indentation, empty eccentricity and hilar mediastinal lymph nodes when the diagnosis is more difficult, often misdiagnosed as peripheral lung cancer . Therefore, the diagnosis requires a comprehensive analysis