Pulmonary tuberculosis (TB) is serious public health problem in India and worldwide. The mortality rate in pulmonary TB is high in those with advanced disease and in presence of complications. It presents with wide variety of complications of which haematological complications are rare. Many cases were reported pulmonary TB associated with deep venous thrombosis, hepatic and portal venous thrombosis, central retinal venous thrombosis and sagittal sinus thrombosis in TB meningitis. We report a rare case of pulmonary TB with pulmonary venous thrombosis and atrial extension. To our best knowledge, this is the first case reported of its kind.