Background: Tuberculosis (TB) empyema is a chronic infection of pleural space which carries a significant morbidity and mortality. Methods: A retrospective study of clinical, radiological, bacteriological features and management of 54 patients with TB pyothorax admitted to a medical college tertiary care teaching hospital at Cuttack, Odisha. Results: Their mean age was 43.2 years; there were 45 (83.3%) males. History of TB was available in 13 (24%) patients, among whom two patients had multidrug-resistant TB. Cough (92.5%), expectoration (87%), fever (75.9%), chest pain (66.6%), were most common presenting symptoms; pallor (46.2%), digital clubbing (44.4%) were the most frequently evident signs. Thirtyone (57.4%) patients had underlying comorbid conditions; diabetes mellitus, alcoholism (n=11 each), were the most frequently present. TB empyema occurred on the right-side in 30 (55.5%), left side in 21 (38.9%) and was bilateral in three patients. Direct smear of pus and sputum revealed acid-fast bacilli in four (7.4%) and eight (14.8%) patients, respectively; mycobacterial culture of pus was positive in 11 (20.3%) cases. Six patients were managed with simple aspiration, 47 patients required tube thoracostomy, one patient was managed with open drainage; two patients were referred to thoracic surgery for the decortication. Category I, II and IV anti-TB treatment was administered to 41 (76%), 11 (20.3%) and two patients, respectively. Secondary bacterial infection in pleural fluid occurred in 26 (48%). Conclusion: Drainage of pyothorax using tube thoracostomy along with effective anti-TB drugs results in good outcome, and many patients may not require surgery.