Purpose. To show diagnostic and treatment difficulties in a patient with pulmonary lesions associated with tuberculosis (TB) and non-tuberculosis mycobacteria.

Results. Taking into account X-ray, anamnesis and examination data, fibrous-cavitary TB of the left operated lung combined with mycobacteriosis was diagnosed in patient. It was complicated by aspergillosis, hemoptysis, cachexia and respiratory failure. Considering the positive dynamics absence after 7 months of chemotherapy and recurrent pulmonary bleedings presence, the patient underwent surgical treatment – VATS pneumonectomy with postponed thoracoplasty on the left. The postoperative period was uncomplicated. At control examination a year after surgery, the patient was in a satisfactory condition, with ability for working.

Discussion. The X-ray picture, as well as the symptoms of mycobacteriosis, are almost indistinguishable from those in TB. There is a faster fibrous-cavitary alterations formation than in TB, and the rare positive x-ray dynamics achievement, even with established drug susceptibility and adequate chemotherapy. We often encounter bilateral, chronically processes with bronchi deformation in the form of bronchiectasis in cases of tuberculosis and mycobacteriosis combination. CT and bacterioscopy data are most important for diagnosis and treatment dynamics monitoring.

Conclusion. This clinical case illustrates the great role of radiological methods in the diagnostic of tuberculosis and mycobacteriosis combined cases, indications for surgical treatment determination and treatment monitoring. Although it is not possible to diagnose mycobacteriosis only with X-ray, this method decisive role in patient’s condition and disorder dynamic monitoring rise no doubts.