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Background: Chylothorax with tuberculous empyema thoracis is a rare disease after coronary artery bypass grafting (CABG). Chylothorax per se can cause nutritional, metabolic, and cardiopulmonary abnormalities and may have significant immunologic consequences. The clinical suspicion of the combined pathology is low due to its rarity and the suspicion of pseudochylothorax, which is usually caused by tuberculosis.

Case Report: We present our case of right-sided chylothorax with tuberculous empyema thoracis after CABG. Clinical suspicion of chylothorax was confirmed biochemically (pleural fluid analysis) after observing that the intraoperatively placed thoracostomy tube drained approximately 500 cc of seropurulent white-to-yellow fluid that showed no debris or clotting tendency. Zeihl-Neelsen staining was done and repeated 3 times with positive results.

Conclusions: Because of the low sensitivity of microbiological examinations of pleural fluid for tubercle bacilli, biopsy of pleura and/or tissue culture should be the method of choice in the diagnosis of TB.