Background and study aim: Tuberculosis (TB) is one of the most prevalent and grave of all humanoid contagious diseases and is still a major infectious disease worldwide. The geriatric population in developed countries represents a big reservoir of tuberculosis infection across all racial and sex subsets. We aim in this study to assess the pattern of TB in elderly patients in Qena governorate in Egypt. Patients and methods: All patients aged 50 years and above who were diagnosed with TB have been included in the study. The patients were evaluated regarding the incidence rate: for new cases, and relapse cases (pulmonary and extra pulmonary). Results: The mean age of included patients was 41.18 years and 51.3% of the studied patients were male. Regarding residence we found 54.7% of patients live in rural areas and 45.3% in urban. 82.9% of the patients were tuberculin positive. As regard chest x-ray finding we found: normal in 17.1% of patients, 17.1% bilateral, 25.6% right upper lobe 16.2% whole right lung, 10.3% left upper lobe, 6% left lower lobe, 3.4% right lower lobe, 2.6% pleural effusion and 1.7% whole left lung. In the present study we found that 81.2% of patients had pulmonary TB and 18.8% had extra pulmonary TB. Conclusion: The study documents important variances in clinical and radiological findings of pulmonary TB in geriatric patients. Sputum analysis for AFB remains a significant, easy and cheap method for diagnosis, but might not be continuously supportive in early diagnosis.