Objective   To investigate the  ultrasonic imaging features of retroperitoneal tuberculous granulation in upper retroperitoneal lymph nodes, so as to provide the imaging basis for clinical diagnosis and treatment.   Methods  The ultrasonic imaging data of one patient with upper retroperitoneal lymphatic tuberculosis granuloma admitted to our hospital were retrospectively analyzed, and the domestic and foreign imaging documents closely related to retroperitoneal tuberculosis were reviewed and analyzed in Wanfang and Pubmed medical network.    Results    In this case, the patient went to the hospital because of dull pain and discomfort in the upper abdomen for 1 month. Color dopper ultrasonography showed upper retroperitoneal cystic solid mass with calcification, tuberculosis was not excluded. There were solid nodules posterior to upper peritoneum. CT showed solid lesions in the upper abdomen with calcification, and multiple larger lymph nodes with calcification. Solid granulomatous lesions and tuberculosis were considered.  OT test of the patient was negative, blood sedimentation rate did not rise, CT examination 2 years ago suggested tuberculosis. Finally, the patient was diagnosed as retroperitoneal tuberculosis with calcification in the lesion. After consultation of a number of clinical experts was recommended follow-up observation, after half a year, no obvious enlargement in the mass size, continued to follow up observation. Ultrasound examination 1 year later showed that the size of the cystic solid mass in the upper retroperitoneum significantly reduced, and the solid nodules in the upper retroperitoneum disappeared.   Conclusions    Retroperitoneal tuberculous granuloma is extremely rare, with characteristic ultrasonic imaging features, providing clear imaging basis for clinical diagnosis and treatment, greatly reducing the incidence of misdiagnosis, misdiagnosis and mistreatment, and effectively reducing the physical and mental pain and economic burden of patients.