<![CDATA[Background: Necrotizing pneumonia (NP) is a severe complication of bacterial pneumonia with progressive lung necrosis and thin-walled cavities. Rare in children, it can be fatal if not promptly treated. Chest CT is the primary imaging for diagnosis. Aim: To report an 8-year-old boy with NP and active pulmonary tuberculosis, emphasizing chest CT's diagnostic role and conservative management outcome without surgery. Methods: An 8-year-old boy presented with 2-week productive cough, fever, dyspnea, prior TB on anti-TB therapy (OAT). Examination: dullness over right lung, bilateral coarse rhonchi. Chest X-ray: right opacity with lucencies. Non-contrast chest CT: extensive right consolidation with multiple thin-walled avascular hyperlucent lesions (0.5–1 cm) and two right upper lobe abscesses (4 cm, 1.8 cm) with air-fluid levels. Left hilar retraction and left upper lobe patchy opacities indicated active TB. Treatment: IV cefotaxime, gentamicin, dexamethasone, paracetamol drip, plus continued OAT. Results: After 8 inpatient days, the patient improved and was discharged without surgery. Chest CT was crucial to differentiate NP from TB cavities and other similar conditions, despite overlapping radiological features. Conclusion: NP in children with active TB poses diagnostic challenges due to overlapping radiology. Chest CT is essential for differentiation. Early combination antibiotics with continued OAT led to favorable clinical improvement without surgical intervention. Keywords: Pediatric, Necrotizing Pneumonia, Lung Abscess, Chest CT.]]>
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