OBJECTIVE: Pleural tuberculosis (TB) remains difficult to diagnose. In about two-thirds of the cases the diagnosis is reliant upon clinical suspicion along with consistent fluid biochemistries (i.e., lymphocytic predominant exudates) and exclusion of other potential causes for the effusion. These cases are to describe the characteristics of pleural tuberculosis which early diagnosed with pleural effusion in pediatric patients.
CASE: First case is a 1 year old boy presented with breathlessness, prolonged fever, cough and flu for almost 2 weeks before hospitalized. History of lung diseases include TB in family was denied. Second, 16 years old boy presented with same chief complaints, but also have hemoptoe, and weight loss. He was on TB treatment. Both physical exams revealed asymmetrical chest movement, decreased tactile fremitus and vesicular breath sound, and dull percussion on affected side. Early diagnosis were pleural effusion. Laboratory findings showed leukocytosis. The chest Xray confirmed. After performed water sail drainage (WSD) in both, blood and urine culture, pleural fluid analysis were performed. Both adenosine deaminase (ADA) test were positive. The first one also diagnosed with hydropneumothorax and ESBL. 
CONCLUSION: In pleural disease, exudative is the most common childhood effusion which is caused by tuberculosis. The possibility of tuberculous pleuritis should be considered in every patient with an undiagnosed pleural effusion, for if this diagnosis is not made the patient will recover only to have a high likelihood of subsequently developing pulmonary or extrapulmonary tuberculosis. Early pleural drainage may have a role in selected cases.