Perez Moreno, PabloBello, Angelica2025-01-202025-01-202024Pérez P, Bello A. Management of chronic pleural tuberculosis and non-tuberculous empyema in the 21st century. Shanghai Chest 2024;8:3https://hdl.handle.net/11447/9678This review addresses complexities in managing pleural tuberculosis (TB) and non-TB empyema. Historically, TB, often termed “the mother of thoracic surgery”, has witnessed a dramatic transformation from invasive surgical interventions to the dominance of medical therapy with the advent of effective anti- TB agents in the mid-20th century. This shift marked a pivotal moment in the treatment landscape, with medical therapy taking precedence and surgical methods reserved for diagnostic purposes or complications. In contrast, the history of non-TB empyema, dating back to Aristotle, evolved from open drainage and open surgery to minimally invasive surgery and fibrinolytic therapy. The review delves into the nuances of these conditions, exploring their clinical manifestations and the state-of-the-art management strategies that have emerged over time. Advancements in imaging modalities, such as computed tomography (CT), complemented by diagnostic laboratory techniques like the GeneXpert MTB/RIF assay, have revolutionized the diagnosis of TB, enhancing accuracy and expediting the process. The review also highlights the distinct clinical presentations of pleural TB and non-TB empyema, underscoring the challenges and intricacies in their management. It thoroughly explores the historical evolution, current diagnostic approaches, and advanced management strategies for these conditions, offering valuable insights for the learner.enEmpyemaPleural Tuberculosis (pleural TB)Pleural empyemaArticlehttps://doi.org/10.21037/shc-23-32