The most common causes of exudative pleural effusion are tuberculosis, malignancy, and pneumonia. However, exudative pleural effusion may also reveal contiguous infectious processes including cholecystitis, subphrenic pus collection, and thoracic vertebral osteomyelitis. In the latter, the diagnosis is usually delayed. We report two cases of thoracic vertebral osteomyelitis presenting as exudative pleural effusion for which the diagnosis could be suspected by a careful analysis of the thoracic imaging studies performed on admission.