Key Points

• Pleural tuberculosis occurs 3 to 7 months after primary pulmonary tuberculosis and is usually secondary to the rupture of a subpleural caseous focus.
• Pleural tuberculosis is self-limited, with 80% of patients achieving complete remission without treatment.
• If pleural tuberculosis is left untreated, 65% of patients will develop active (pulmonary or extrapulmonary) disease within 5 years.
• Pleural needle biopsy of pleural tuberculosis for histologic and microbiologic study has 80% to 90% sensitivity.
• Treatment of pleural tuberculosis consists of 6 months of chemotherapy.
• Tuberculous empyema results from the rupture of a parenchymal pulmonary tuberculous focus with a large number of organisms spilling into the pleural space.
• In acute tuberculous empyema, bronchopleural fistula is usually present.
• Chronic tuberculous empyema may develop if an acute empyema is not recognized or is not properly treated.
• The treatment goals for tuberculous empyema are to clean the pleural cavity until the space is sterile and to obliterate the residual pleural space.