Tuberculous empyema is a chronic, active infection of the pleural space characterised by a thick rind of pleura with dense and irregular calcification of both the parietal and visceral pleura usually surrounding a loculated pleural fluid which contains a large number of tubercle bacilli 1. This could act as a fibrothorax
It is different from the more common tuberculous pleural effusion which is an inflammatory response to a localised paucibacillary pleural infection with tuberculosis.
Treatment and prognosis
Treatment consists of pleural space drainage, decortication to allow re-expansion of the trapped lung and decortication plus pneumonectomy to remove a lung 2. Adjuvant antituberculous chemotherapy may also be given, but usually leads to development of drug resistance as the drugs are unable to cross the thick calcified pleural barrier 3.
- 1. Sahn SA, Iseman MD. Tuberculous empyema. Semin Respir Infect. 1999;14 (1): 82-7. Pubmed citation
- 2. Long R, Barrie J, Stewart K et-al. Treatment of a tuberculous empyema with simultaneous oral and intrapleural antituberculosis drugs. Can. Respir. J. 2008;15 (5): 241-3. Free text at pubmed - Pubmed citation
- 3. Elliott AM, Berning SE, Iseman MD et-al. Failure of drug penetration and acquisition of drug resistance in chronic tuberculous empyema. Tuber. Lung Dis. 1996;76 (5): 463-7. Pubmed citation