Pulmonary tuberculosis (PTB) diagnosis relies primarily on bacteriological confirmation via GeneXpert MTB/RIF and sputum culture. However, 30–50% of patients cannot produce adequate sputum, and culture results often take up to eight weeks, delaying treatment in high-burden settings like the Philippines. Limited data exist on chest computed tomography (CT) patterns in bacteriologically confirmed PTB to aid sputumnegative or sputum-limited cases. This study characterized chest CT findings in GeneXpert-positive PTB patients and established radiological–bacteriological correlations for patients unable to undergo confirmation. A retrospective observational study at a Philippine tertiary hospital (January 2020–December 2024) included 926 adults tested via sputum GeneXpert. Of these, 100 met criteria: 33 GeneXpert-positive and 67 GeneXpert-negative. CT scans were assessed for cavitation, reticulonodular densities, calcified nodules, fibrotic bands, bronchiectasis, consolidation, pleural effusion, ground-glass opacities, and mediastinal lymphadenopathy. Analysis used Pearson’s chi-squared test and correlation coefficient. Cavitation was significantly more frequent in GeneXpert-positive cases (p = 0.039), with reticulonodular densities showing the strongest association (p = 0.003). Aortopulmonary/paraaortic lymphadenopathy (p < 0.001) and perivascular involvement (p = 0.024) strongly correlated with positivity. Precarinal lymphadenopathy prevailed in positives (27.3% vs. 10.4%, p = 0.031), while paratracheal was more common in negatives (14.9% vs. 3.0%, p = 0.015), indicating alternative etiologies. Specific CT patterns— cavitation, reticulonodular densities, and mediastinal lymphadenopathy—are significantly linked to confirmed PTB. These support radiological criteria for timely diagnosis and treatment in sputum-limited patients, reducing delays and bolstering TB control in endemic areas. 

Adrian Cecily T. Beldad completed her Internal Medicine training at age 30. She is currently a secondyear Pulmonary Medicine Fellow and Chief Fellow at Cebu Doctors' University Hospital, with plans to pursue Critical Care Medicine subspecialty training. She presented a case report at the American Thoracic Society (ATS) in May 2025 and has two case reports accepted for the Japanese Respiratory Society meeting in April 2026.