Pulmonary tuberculosis (TB) remains one of the most consequential infectious diseases globally, responsible for significant morbidity and mortality across all age groups, and continues to pose a formidable challenge to public health systems in both high-burden and resource-limited settings. A primary limitation in the timely clinical management of pulmonary TB has been the inherent delay associated with sputum culture confirmation, which may require several weeks and during which critical treatment decisions must be made on the basis of clinical and radiological evidence alone. High-resolution computed tomography (HRCT) of the chest offers a non-invasive and rapidly available imaging modality that can identify characteristic morphological features of active and inactive pulmonary TB, and has the potential to guide early therapeutic decisions when microbiological data are awaited. The present cross-sectional study was designed to compare HRCT findings with sputum positivity status in 40 patients with confirmed or clinically suspected pulmonary TB, thereby evaluating the utility of specific HRCT features in distinguishing active from inactive disease. Of 40 patients enrolled, 24 were classified as having active TB based on sputum smear positivity and 16 as having inactive disease. Statistical analysis using Fisher's exact test demonstrated that centrilobular nodules (p=0.0001), tree-in-bud pattern (p=0.003), consolidation (p=0.004), and cavitation (p=0.022) were significantly more prevalent in active disease, while fibrosis (p=0.008) and tractional bronchiectasis (p=0.023) showed a significantly higher prevalence in inactive cases. Ground glass opacity, lymphadenopathy, emphysema, pleural effusion, calcified granuloma, and pleural thickening did not demonstrate statistically significant differences between the two groups. These findings collectively affirm that HRCT can meaningfully contribute to the prediction of TB disease activity, supporting its role as a complementary diagnostic tool in clinical practice, particularly in settings where rapid microbiological confirmation is unavailable.