ADA and Granuloma: Even though the gold standard for the diagnosis of TB pleuritis remains the detection of mycobacterium TB in pleural fluid, or pleural biopsy specimens, either by microscopy and/or culture, or the histological demonstration of caseating granulomas in the pleura along with acid fast bacilli [18], pleural ADA testing being noninvasive and inexpensive is an invaluable tool for rapid and accurate diagnosis in developing countries like Pakistan.