Abstract: Objective To summarize the clinical patterns and specific imaging manifestations of active tuberculosis during pregnancy, so as to provide evidence for optimizing clinical diagnosis and treatment strategies. Method A retrospective analysis was conducted on the clinical data, including clinical features, laboratory tests, imaging, and etiology, of 23 patients with pregnancy complicated by active tuberculosis admitted to Hunan Chest Hospital and The Inner Mongolia Fourth Hospital from January 2020 to December 2024. Result The 23 patients ranged in age from 19 to 39 years, among whom 17 were rural residents (73.91%). Cough and expectoration were the most common clinical manifestations, while poor appetite, fever, fatigue and other symptoms were also relatively frequent. In terms of pregnancy stage, there were 16 cases of early pregnancy, 5 cases of second-trimester pregnancy, 1 case of third-trimester pregnancy and 1 case of puerperium. In terms of tuberculosis types, 15 cases (65.22%) were secondary pulmonary tuberculosis,among which 11 cases showed patchy exudation, cavitation, and tree-in-bud opacities on chest CT, mainly distributed in the apical-posterior segments of bilateral upper lobes and superior segments of the lower lobes; 4 cases had atypical imaging manifestations with clustered micronodules and reversed halo sign. Hematogenous disseminated pulmonary tuberculosis was the next most common (4 cases, 17.39%), including 3 cases post-in vitro fertilization and 1 case postpartum.Among the 15 cases of secondary pulmonary tuberculosis, a total of 16 lesion-sites of concurrent extrapulmonary tuberculosis were identified, including 9 cases of bronchial tuberculosis, 3 cases of cervical lymph node tuberculosis, 2 cases of tuberculous pleurisy, and 1 case each of laryngeal tuberculosis and urinary tuberculosis. Among the 4 cases of hematogenous disseminated pulmonary tuberculosis, a total of 5 lesion-sites of concurrent extrapulmonary tuberculosis were identified, including 3 cases of meningeal and parenchymal tuberculosis, 1 case of spinal meningeal tuberculosis, and 1 case of tuberculous pleurisy.As for pregnancy outcomes, 20 cases (86.96%) underwent abortion or induced labor, 2 cases had preterm delivery, and 1 severe case received emergency uterine curettage due to incomplete abortion, resulting in maternal and fetal death. Conclusion Pregnancy complicated with active tuberculosis is often clinically nonspecific, predominantly affecting women in rural areas and during early pregnancy. It presents with diverse imaging manifestations, rapid disease progression, and a high incidence of multi-site tuberculosis, resulting in poor maternal and infant prognosis. These findings highlight the need for strengthened early identification, accurate diagnosis, and timely intervention in clinical practice.

Key words: Pregnancy, Active tuberculosis, Clinical features, Imaging features, Pregnancy outcome