Tuberculous empyema is a chronic, active infection of the pleural space characterized 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 localized 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.
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