Background: Tuberculosis (TB) remains a significant health burden among children, particularly in high-burden regions. Early diagnosis is crucial to reducing morbidity and mortality. Chest radiography (CXR) remains a commonly used diagnostic tool, but its accuracy in pediatric populations requires further evaluation.To assess the diagnostic utility of chest radiography in detecting pulmonary tuberculosis among pediatric patients. Methods: An observational study was conducted involving 100 pediatric patients (aged <18 years) suspected of pulmonary tuberculosis. Clinical evaluation, chest radiography, and microbiological testing (sputum smear microscopy, GeneXpert MTB/RIF, or gastric lavage culture) were performed. Radiographic findings were correlated with microbiological confirmation to assess diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The mean age of participants was 8.2 ± 3.4 years, with 55% males. The most frequent clinical symptoms included persistent cough (80%), fever (72%), and weight loss (45%). Abnormal CXR findings were observed in 70% of patients, with hilar lymphadenopathy (42%) being the most common abnormality. Tuberculosis was microbiologically confirmed in 58% of cases. Chest radiography demonstrated a sensitivity of 91.4%, specificity of 59.5%, PPV of 75.7%, and NPV of 83.3%. Conclusion: Chest radiography demonstrates high sensitivity but moderate specificity in diagnosing pediatric pulmonary tuberculosis. While it remains a valuable initial screening tool, microbiological confirmation remains essential for definitive diagnosis.