To evaluate the efficacy of drainage achieved by thoracoscopy vs tube drainage alone.

To compare clinical outcomes such as length of hospital stay, need for additional procedures, and treatment failure rates between the two drainage methods.

To asses resolution of pleural infection and rates of fluid re-accumulation over follow-up.

To compare safety profiles and complication rates of thoracoscopy versus tube drainage alone

Empyema is a serious infection characterized by pus accumulation in the pleural space. Effective drainage and treatment is necessary for resolution. Traditionally, intercostal tube placement was standard initial management. However, recent studies have compared outcomes of early medical thoracoscopy or video-assisted thoracoscopic surgery (VATS).

Thoracoscopy enables direct visualization for thorough pleural space cleansing and debridement under direct vision. medical thoracoscopy significantly improved drainage adequacy and reduced treatment failure risks compared to tube drainage alone. Also reported shorter hospital stays and lower complication rates with early thoracoscopy-directed management.

Additional benefits of thoracoscopy include enabling talc pleurodesis for reducing empyema recurrence. thoracoscopy-directed pleurodesis achieved higher long-term success rates than tube drainage followed by pleurodesis. Overall, current evidence indicates medical thoracoscopy provides superior empyema treatment outcomes to conventional tube drainage through optimized drainage and debridement under direct visualization.

Inclusion Criteria:

• Confirmed diagnosis of empyema via Imaging tests (e.g. chest x-ray/CT scan)
• Age 18 years or older
• Clinical signs/symptoms consistent with Empyema such as fever, chest pain, coughs
• Pleural fluid loculations/septations seen on Imaging requiring drainage
• No previous drainage procedures done for Current empyema

Exclusion Criteria:

• Age less than 18 years
• Immunocompromised state or other conditions Contraindications to thoracoscopy
• Previous drainage procedure for current Empyema
• Residual pleural fluid not amenable to drain

Intercostal chest tube group