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Published on: February 27, 2026
Thoracoscopic diagnosis of tuberculous pleuritis mimicking pleural malignancy with chest wall involvement: a
Muhammad Nour Talal Rshrash1, Ahmed Saleh2, Anas Abdulrazzak2
1Faculty of Medicine, Damascus University, Damascus, Syria. muhammadrshrash@gmail.com.
Background:
Tuberculous pleuritis is a common form of extrapulmonary tuberculosis that may closely mimic pleural malignancy, particularly when associated with loculated effusion, pleural thickening, or chest wall involvement. This diagnostic challenge is amplified in resource-limited settings.
Case Presentation:
We report a 41-year-old male with a 30 pack-year smoking history who presented with a two-month history of pleuritic chest pain, dyspnea, night sweats, and significant weight loss. Imaging revealed a large loculated right-sided pleural effusion with diffuse pleural thickening and associated rib destruction, raising strong suspicion for pleural malignancy. Thoracentesis demonstrated a lymphocyte-predominant exudative effusion. Due to limited diagnostic resources, advanced microbiological investigations were unavailable. The patient underwent video-assisted thoracoscopic surgery (VATS), which revealed diffusely thickened pleura with multiple whitish plaques. Histopathological examination revealed caseating granulomatous inflammation consistent with tuberculous pleuritis. The patient responded well to anti-tuberculous therapy.
Conclusions:
Tuberculous pleuritis can mimic pleural malignancy, particularly in the presence of chest wall involvement. Thoracoscopic pleural biopsy remains a highly valuable diagnostic tool in cases where non-invasive investigations are inconclusive or unavailable.
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