Background: Tuberculous pleural effusion (TPE) is a significant global health problem, particularly in high-prevalence regions such as India. Early diagnosis is crucial for effective treatment of this condition. Medical thoracoscopy offers a superior diagnostic yield compared with traditional methods. This study aimed to evaluate various thoracoscopic appearances in TPE, their diagnostic utility, and their correlation with microbiological and histopathological findings. Materials and Methods: This hospital-based prospective observational cross-sectional study was conducted at a tertiary care teaching hospital in eastern India, from 2023 to 2024. One hundred and twenty-one patients with suspected TPE underwent thoracoscopy, and the findings were classified into 11 categories. Pleural biopsies were examined, and the data were analyzed. Results: One hundred and three patients were confirmed to have TPE. The most common thoracoscopic findings were easily peelable pleura and adhesions. Significant associations ( P <0.05) were found between thoracoscopic findings of pustules and positive Cartridge-Based Nucleic Acid Amplification Test results, as well as between easily peelable pleura, multiple variable-sized nodules, and positive mycobacterial culture. Pustules, sago grain nodules, and a few discrete nodules were the most specific findings, with a high positive predictive value. Normal-looking pleura were also observed in TPE. Easily peelable and hard-to-peel pleura were novel findings in our study. Conclusion: Medical thoracoscopy is a valuable diagnostic tool for TPE exhibiting various gross pleural appearances, and targeted biopsy of various lesions increases the yield of microbiological and histopathological analyses. Findings such as pustules, sago grain nodules, and a few discrete nodules are highly specific for TPE, allowing for the early initiation of antitubercular therapy even before microbiological confirmation.
Thanisk et al. (2026) studied this question.