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Lung carcinoid tumors, pulmonary tuberculosis (TB), and upper respiratory infections (URIs) present with overlapping symptoms, making accurate diagnosis challenging. This case report illustrates the diagnostic difficulties and the critical role of advanced imaging in distinguishing these conditions. We describe a 58-year-old Southeast Asian non-smoker woman with a history of pulmonary TB who presented with intermittent hemoptysis over four months. Initial treatments for URIs and TB, including multiple courses of antibiotics and chest X-rays, did not alleviate her symptoms. Advanced imaging with a CT scan revealed a 3 × 3 cm nodule in the retrocardiac area of the left lower lobe, leading to a diagnosis of a lung carcinoid tumor following biopsy. The patient underwent a left lower lobe lobectomy, which resulted in significant clinical improvement. This case highlights the limitations of initial diagnostic approaches and underscores the importance of advanced imaging techniques such as CT and PET/CT in accurately identifying and characterizing lung tumors. These modalities are essential not only for diagnosing but also for guiding appropriate treatment and improving patient outcomes. Advanced imaging allows for precise differentiation between lung carcinoid tumors, TB, and URIs, ensuring that patients receive timely and effective management. The findings of this case reinforce the need for comprehensive imaging in the evaluation of persistent respiratory symptoms, advocating for the integration of advanced imaging into routine clinical practice to enhance diagnostic accuracy and treatment efficacy., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aung et al.)