Granulomatous inflammation is a form of delayed type hypersensitivity reaction that is involved in protection against chronic infections. Granulomatous inflammation can also occur without any clear inciting stimulus such as in sarcoidosis. An in depth knowledge of granuloma formation is essential to our understanding of protection against chronic infection as well as the dysregulation which occurs in granulomatous diseases of unknown origin. Granuloma formation is a complex and dynamic process involving the recruitment and coordination of diverse cell types. This review is focused on the important roles that T cells play in initiating and building the granuloma as well as in mediating effector functions and eventually resolving granulomatous inflammation. CD4(+) T cells emerge as the central mediators of this process, with T cells from other subsets also participating in the later phases of granuloma formation.