Empyema thoracis is a pyogenic or suppurative infection of the pleural space. Empyema are the most common exudative type of pleural effusion.Empyema is never a primary disease, though it is often difficult to arrive at primary focus of infection,most common cause of empyema is sequela of inadequately treated pneumonia.Acute empyema is treated by antibiotics,immediate drainage of pus via aspiration,intercostal drainage tube insertion with or without the help of thoracoscope. Thoracoscopy is an alternative procedure for multiloculated empyema which is considered in patients who do not respond to antibiotics and drainage. With thoracoscopy, Theloculations in the pleural space can be disrupted and the pleural space can be drained completely.Thoracoscopy early in the management of fibrinopurulent stage of empyema is more effective.If extensive adhesions are present or thick pleural peel entraps the lung, the procedure may be converted to open thoracotomy and decortications.In case where there is much thickening of the pleura, Decortication is the treatment of choice. It allows delicate parenchyma of lung to expand. and patients are explained breathing, exercises to promote early expansion of lung.