Pleural and parenchymal radiological characteristics of tuberculous pleuritis and correlation with microbiological and molecular diagnostic yield

Tuberculous (TB) pleuritis is a common extrapulmonary manifestation of the disease, with significant healthcare burden and morbidity. While there is increasing use of computed tomography (CT) scans for evaluation of patients with suspected TB pleuritis, little is known regarding the correlation of CT findings and respiratory and pleural specimen microbiological yield. We performed a retrospective analysis of radiological features and microbiological and molecular yield from different diagnostic modalities in patients with TB pleuritis from January 2021 to December 2024. A total of 80 patients were included in this study, with 78.8% male and a median age of 62 (interquartile range: 45–73 years). Approximately half (53.8%) of patients had parenchymal abnormalities on chest radiographs. CT imaging was performed in 67 patients, of whom 80.6% (54/67) had pleural thickening or nodularity, and 82.1% (55/67) had features of active pulmonary TB. Mycobacterium Tuberculosis Complex (MTC) was isolated from sputum culture in 33.3% (11/33) of patients with CT features of active pulmonary TB, compared to 0% (0/5) in patients without. A higher proportion of patients with pleural thickening or nodularity on CT had MTC isolated from pleural biopsy samples, compared to patients without (84.0% vs. 25.0%, p = 0.010). There was no difference in the yield of pleural fluid TB culture between patients with and without pleural abnormalities on CT imaging (48.1% vs. 50.0%, p = 0.908). CT features of active pulmonary disease or pleural thickening are common with TB pleuritis, and are useful to guide the diagnostic workup of patients with suspected TB pleuritis.