BACKGROUND: Tuberculous pericarditis begins with fibrinous and hemorrhagic pericarditis, followed by pericardial effusion, then pericardial hypertrophy, which may turn into subacute or chronic stage, and partly develop into pericarditis. Early diagnosis and treatment have very important clinical significance. CASE SUMMARY: We present a case of an 82-year-old man with a known history of hypertension who was admitted for pleural effusion. CT scan of the chest showed findings of pleural effusion. An echocardiographic study during admission revealed a small amount of pericardial effusion (~1.2 cm in thickness). A whole-body positron emission tomography-computer tomography (PET-CT) scan was then performed and showed a slightly increased fluorodeoxyglucose uptake in the entire pericardium considering tuberculosis. He was started on antituberculosis (TB) medications and tolerated them well. Follow-up echocardiographic study showed no re-accumulation of pleural effusion and pericardial fluid. CONCLUSION: Transudative-exudative pleural effusion may be one of the clinical manifestations of tuberculous pericarditis. (1) Bilateral leaking pleural effusion may be the early clinical manifestation of tuberculous pericarditis
(2) PET/CT in the diagnosis and efficacy evaluation of tuberculous pericarditis is valuable
and (3) the central venous pressure may be an indicator of choice for treatment of tuberculous pericarditis.