Mycobacterium tuberculosis (M. tuberculosis) is a pathogenic bacterial species in the family Mycobacteriaceae and the causative agent of most cases of tuberculosis (TB) (1). Despite being isolated by Robert Koch in 1882, as well as the availability of effective treatment and the use of a live attenuated vaccine in many parts of the world, TB remains one of the deadliest communicable diseases. In 2013, an estimated 9 million people developed active TB, with 1.5 million deaths attributed to the disease (2). According to the World Health Organisation the incidence of pulmonary TB in some regions is as high as 1,000 cases per 100,000 persons (2). Although TB affects the lungs in the majority of patients, extrapulmonary TB serves as the initial presentation in about 25% of adults, and primarily involves the lymph nodes and pleura (3). This review gives an overview of the pathogenesis, clinical presentation, diagnosis and treatment of TB pleural effusions, highlighting recent advances and controversies.