BACKGROUND: Tuberculosis is a more devastating disease in the elderly with increased morbidity and mortality, affecting quality of life in geriatric age group. Its clinical and radiographic features may be atypical, non–specific, or confused with coexisting diseases .AIM: To compare clinical and radiological finding between new and previously treated pulmonary tuberculosis cases of geriatric age group. METHODS: This prospective study was conducted on 110 pulmonary tuberculosis patients of age ≥60 years. Blood investigations, chest x–ray, sputum smear examination by microscopy under RNTCP, sputum /BAL for CBNAAT was performed. The results were analysed using appropriate statistical tests. RESULTS: In both groups, majority were   male (83.64%), 42% of them were smokers. COPD (29%), Diabetes mellitus (17%) and hypertension (10%) were the common co–morbidities. There was no statistically significant difference in symptoms between study groups. In both groups consolidation was the most common radiological finding. Infiltration and hilar adenopathy was found significantly more in new TB cases. Fibrocavitary lesion and pulmonary fibrosis were common in previously treated patients. CONCLUSION: The two groups do not differ clinically but to some extent radiological presentation varied .Treating  physician  should  be  aware  about  the  radiographic  features of previously treated pulmonary  TB  in  geriatric  age  group  and  strictly adhere to the diagnostic algorithm proposed by RNTCP for early management to improve quality of life because geriatric patients already have co–morbidities.