[Purulent pleurisy]

Management of thoracic empyema remains controversial considering local treatment and place of surgical intervention. If French practitioners use primarily iterative thoracentesis and pleural lavage, reserving thoracic drainage for cases of failure of thoracentesis, American authors recommend a more aggressive initial approach, with thoracic drainage and surgical intervention. However, conservative attitude, combining immediate thoracocentesis and pleural lavage with intrapleural fibrinolytic therapy of loculation occurs, may also be proposed. Prospective studies are warranted to evaluate the different methods used to evacuate empyema and validate new procedures as pleural catheters inserted under radiologic guidance and thoracoscopy versus conventional approach.