We describe two cases of primary macronudular hepatosplenic tuberculosis (TB) with US, CT, and MR findings. The clinical presentation of the two patients were not alike. Whereas the first presented with a long indolent course, the second presented with an acute picture. For the first patient TB was not suspected until laparatomy; for the second the diagnosis was made by clinical evaluation with the aid of US and CT, and confirmed by biopsy. Use of MR did not add to the diagnosis. © 1995 Springer-Verlag.