The diagnosis of tuberculous pleurisy is mainly based on the patient’s symptoms and auxiliary examination to make a comprehensive judgment. 1. Symptoms: Tuberculous pleurisy may present with fever, chest pain, dyspnea, cough, sputum and other symptoms. 2. Auxiliary examination (1) Chest radiograph, chest CT, chest ultrasound: chest radiograph and chest CT can show pleural effusion with or without lung lesions; chest ultrasound can show pleural effusion, which may be accompanied by pleural thickening and adhesion. (2) Pleural fluid examination: pleural fluid is mostly yellow, occasionally can be pale blood, for exudative pleural fluid. Cells in pleural fluid are mainly lymphocytes, and increased ADA in pleural fluid has high diagnostic value. Antacids can be detected in pleural fluid, but the positive rate is very low. (3) PPD skin test: positive PPD skin test or T-SPOT supports the diagnosis of tuberculous pleurisy. (4) Pleural biopsy: pleural puncture biopsy is needed if necessary to confirm the diagnosis by pathologic examination. The diagnosis of tuberculous pleurisy is difficult to confirm by finding antacid bacilli in pleural fluid, and the clinical diagnosis is often made based on the color and nature of pleural fluid, combined with clinical symptoms, and excluding other possible diseases. It is recommended to actively seek medical attention if discomfort occurs, so as not to delay the condition.