Sago‐like appearance of pleura in Tuberculosis- A case repor
Medical thoracoscopy is an excellent tool for evaluation of exudative pleural effusion, and sago‐like appearance of parietal pleura is highly specific for tuberculosis.

A 24‐year‐old lady presented with history of cough, fever, and weight loss for four weeks. Chest radiograph revealed presence of left pleural effusion. Pleural fluid was exudative (protein 3.8 gm %) and lymphocytic (90%) and had low ADA (14 U/L). Cytology revealed no malignant cells. Contrast‐enhanced computed tomography of the thorax showed left‐sided moderate effusion with collapse of left lower lobe. Medical thoracoscopy revealed diffuse thickening of parietal pleura with multiple nodules imparting "sago"‐like appearance. Few nodules had crumbly cheese‐like appearance. Tuberculosis was diagnosed.

“Sago”‐like nodules are the most common visual appearance, and its presence has high specificity and positive predictive value to make a diagnosis of tubercular pleural effusion. In the index case, thoracoscopic biopsy revealed multiple aggregates of epitheloid cell granulomas with multinucleated giant cells, caseous necrosis, and multiple acid fast bacilli on Zeihl Neelsen stain confirming the diagnosis of tuberculosis. Medical thoracoscopy is an excellent diagnostic modality for exudative pleural effusion, and its yield in tuberculosis is very high.