Pulmonary gangrene is an uncommon but life-threatening complication of bacterial pneumonia. Only four cases of pulmonary gangrene due to Mycobacterium tuberculosis have been described to date; another case of pulmonary gangrene was attributed to unidentified mycobacteria. We report a fatal case of tuberculous pulmonary gangrene (TPG) and review the literature on this infection. To our knowledge this is the first case of TPG documented by thoracic computed tomographic scanning. Radiological features of pulmonary gangrene are distinctive, and identification of pulmonary parenchyma in the mass on computed tomography may be considered as pathognomonic. Analysis of the six cases revealed that most of the patients were aged, and one-half of them were alcohol abusers. Right-upper-lobe involvement predominated. When performed, sputum smears disclosed acid-fast bacilli. M. tuberculosis was cultured from sputum or pathologic material in five of the six cases. Four patients (66.7%) died. Four of six patients with TPG received antituberculous therapy, and two of them survived; no patient underwent surgical intervention. Although surgical management has been successfully employed in cases of bacterial pulmonary gangrene, TPG has always been treated with medical therapy alone. In spite of administration of antituberculous therapy, mortality is high. © 1994 by The University of Chicago.