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Case of the Week 305 
What's the most likely diagnosis?
- 71 year old with cough
- Hepatocellular carcinoma
- Asbestos-related pleural disease
- Chicken pox pneumonia
- Tuberculous empyema
- Aortic dissection
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Answer:
4. Tuberculous empyema
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Tuberculous Empyema
General Considerations
- Represents a chronic, active infection of the pleural space
- The empyema contains many tubercle bacilli
- Empyemas are rare compared to reactive effusions in TB
- They result from numerous organisms spilling into pleural space
- Usually from rupture of a cavity, or
- Via a bronchopleural fistula
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