Science and Education Publishing American Journal of Medical Case Reports 2 8 2014 09 02 Cavitary Lung Disease: Not Always due to Tuberculosis! Primary Lung Cancer with Smear Positive Pulmonary Tuberculosis- A Case Report 164 166 EN Shital Patil Department of Medicine, MIMSR Medical college, Latur, India Halkanche Gajanan AJMCR2014286 10.12691/ajmcr-2-8-6 2014 08 20 2014 08 28 2014 09 02 Pulmonary Tuberculosis is the leading cause of cavitary lung disease globally. Although clinical scenario of majority of the disorders causing cavitation and hemoptysis are overlapping, special emphasis should be given on smoking history and concomitant clubbing especially in elderly population. CT thorax will differentiate probability of malignancy as cause of cavity by delineating its pericavitary nodularity, irregular wall, thickness and size. Bronchoscopy is must in all the cases, will help to confirm the diagnosis and ruling out underlying malignancy. Squamous cell carcinoma is known to cause cavitation and the only histological lung cancer type causing such radiological abnormality. In this case report we described a elderly male patient presented with persistent intermittent hemoptysis with chest pain and clubbing on clinical evaluation. Initially diagnosed as a case of smear positive pulmonary tuberculosis finally we confirmed as Primary Lung cancer of Squamous cell origin. High index of suspicion is must in such cases, with bronchoscopy and cytopathology expertise in lung histopathology will be crucial in confirming diagnosis.