Abstract Introduction There is limited data on the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB). If the diagnostic accuracy of CUS for pulmonary TB (PTB) is similar to that for CUS in diagnosis of pneumonia, CUS could play an important role in diagnosis of PTB in areas without ready access to chest x-ray. Aim of the work This study aimed to describe the diagnostic features and utility of CUS in TTB. Comparing CUS findings in PTB versus community acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP to Abbasia Chest hospital between May 2019 to April 2020 were enrolled in this cohort study. CT of the chest, CUS, mediastinal ultrasound (US) and abdominal US to detect pericardial effusion were performed. CUS lesion pattern in thoracic TB, pulmonary TB and CAP cases were recorded. Results Sub-pleural nodules (97 patients, 95%), air-bronchograms (79 patients, 77,45%) and sub-pleural consolidations (SPC) (77 patients, 75.49%) were the most frequent features recorded by CUS in TB patients, CUS was able to report; pleural gap (28 patients, 27%), fragmented pleura (35 patients,34%), sub-pleural fluid collection (3 patients, 2.9%), and sub-pleural nodules (97patients, 95%) not detected by CT with P value < 0.05 for all. CUS was not only equal to CT in visualizing air-bronchogram (24 patients, 96%) and pleural effusion (4 patients,100%) in CAP, but also could detect fragmented pleura (12 patients, 48%) and SPC (8 patients, 32%) not detected by CT with P value < 0.05 for all. Conclusion CUS was more accurate than CT chest in diagnosis of TTB and CAP, it can report new patterns (pleural gap, fragmented pleura, sub-pleural fluid collection, SPN and SPC) not detected by CT.