Background: Chronic Pulmonary Aspergillosis (CPA) often follows pulmonary tuberculosis, posing diagnostic and therapeutic challenges in surgical practice. Objective: To study the prevalence, clinical predictors, and surgical outcomes of CPA in a tertiary care setting. Methods: A prospective, cross-sectional study was conducted on 35 patients between December 2023 and January 2025. Patients were diagnosed based on radiology, microbiology, and serology. Surgical intervention was offered in selected cases. Results: CPA was confirmed in 12 patients (34.3%). History of tuberculosis (83.3%), COPD (41.7%), and diabetes mellitus (25%) were significantly associated. Four patients underwent surgery with favorable outcomes. Conclusion: Surgical management is safe and effective in localized CPA with hemoptysis or unresponsive symptoms. Surgeons must maintain a high index of suspicion in TB-endemic regions.