It has not been called the white death for nothing. That is because of the phlegm.
Most people associate TB with the lungs. While a favorite place it can infect other parts of the body as well. It can infect the lungs and other parts. It can infect other parts and not the lungs. It is a bacteria. That eats. Pockets are a result.
Most blood tests are not testing for that. If a person that wasn't tested went to a doctor with a picture of phlegm that looked like the pic you've posted and asked for a TB test they'd likely get one.
TB was once thought wiped out in the states. This is no longer the case. A good number of doctors do not have it on their radar for people that have not lived overseas yet.