We report a case of a 60-year old male, previously treated for pulmonary tuberculosis, who presented with complaints of bilateral mass descending per anterior nares and nasal block. Imaging confirmed the diagnosis of bilateral nasal polyposis and additionally revealed total pulmonary fibrosis of left lung, elevation of the left hemi-diaphragm, herniation of the right lung, and reduced heart borders. A diagnosis of bilateral nasal polyposis and total pulmonary fibrosis of the left lung as sequelae of pulmonary tuberculosis with compensatory emphysema of the right lung was made. What was interesting was that despite the totally fibrosed lung, the patient's SpO2 was normal, showing the degree of compensation by the right lung and accounting for why the total pulmonary fibrosis was only incidentally diagnosed. Pulmonary fibrosis is an irreversible complication with permanent respiratory function compromise - as there is no cure, slowing down the progression is the main form of treatment with pneumectomy. We present this case to highlight the fact that even though compensatory emphysema of one lung could allow for normal oxygenation and prevent complete respiratory compromise, despite total lung fibrosis of the other, the sequelae of tuberculosis and their damaging effects, especially in the elderly, need more emphasis. We also briefly discuss the need for better understanding the immunopathogenesis of pulmonary impairment after TB (PIAT).