Thoracic empyema is a disease of significant morbidity and mortality. We performed a prospective study over a one year period with the aim of diagnosing Tuberculous Empyema.  Medical Thoracoscopy was done in all patients to make definite diagnosis. 32 patients of empyema were seen during the study period, of which 22 (68.7%) were of nontuberculous etiology while tuberculous Empyema constituted 10 (31.2 %) cases. Tuberculous empyema was more frequent in younger population compared to nontuberculous empyema. Mean duration of chest tube drainage was longer in patients with Tuberculous Empyema. 12 patients required surgery (5 Tubercular) and 1 patient of Tuberculous Empyema died. Diagnosing Tuberculous Empyema is difficult often requiring invasive procedures. Tuberculous empyema differs from nontuberculous empyema in the age profile, clinical presentation, management issues and has a significantly poorer outcome.