Tuberculous Pleural Effusion

Tuberculosis (TB) has traditionally been one of the major causes of pleural disease and until the earlier decades of the past century held as a principal paradigm of “pleuritis”. Indeed in the presence of a distinctly exudative effusion and a compatible clinical presentation the widely used term “pleuritis exudativa” insinuated a tuberculous aetiology and has therefore been understood to be synonymous with “pleuritis exudativa tuberculosa”. Whilst in the era of TB decline in the Western hemisphere the term “pleuritis exudativa” (which actually is a tautol‐ ogy!) has largely survived but should now describe exudative effusions in general, the full and precise term “pleuritis exudativa tuberculosa” is therefore suggested whenever the possibility of a tuberculous background is addressed. Otherwise the term “tuberculous pleurisy” or “tuberculous pleuritis” is used to describe this entity, in some countries also the term “specific pleurisy” is common. Apart from acute pleuritis exudative tuberculosa, TB of the pleura may however rarely present as a rather chronic disease state in terms of caseous pleurisy or specific (i. e. tuberculous) empyema, respectively. The following chapter reviews the different features and mechanisms of tuberculous pleural involvement as well as their diagnostic and thera‐ peutic implications.