Endobronchial tuberculosis, while relatively common before the advent of effective antituberculosis chemotherapy, is seldom recognized now. Four patients with what appeared to be primary tuberculosis complicated by endobronchial spread were recently seen by us. Three of the four patients presented with anterior segment upper lobe disease with partial segmental collapse. Clinically and roentgenographically, all four patients were felt to have primary bronchogenic carcinoma. Definitive diagnosis was established via the fiberoptic bronchoscope. The declining incidence of tuberculosis in the United States has altered the clinical and roentgenographic presentation. The diagnosis of tuberculosis should be considered even when the clinical features are atypical.