In a 13-year-old boy, a progressively enlarging solitary nodule in the left lung was found on chest CT. He had no symptoms of tuberculosis, no known exposure, and a negative tuberculin test. Imaging findings mimicked a peripheral pulmonary hamartoma, so a video-assisted thoracoscopic resection was planned. During the operation, extensive dense pleural adhesions were found, complicating the procedure. Pathological examination confirmed pulmonary tuberculosis, which was supported by positive tests for acid-fast bacilli, PCR for Mycobacterium tuberculosis and T-cell immunospot test. The patient recovered without complications, received standard antituberculosis treatment, and did not relapse during the 12-month follow-up. The article recommends considering tuberculosis for solitary pulmonary nodules in children in endemic areas, combining the interferon-gamma release test with the tuberculin test, and considering needle biopsy. Before surgery in pediatric patients with tuberculosis, pleurisy should be assessed and antituberculosis treatment may be initiated to reduce the risks.