الفهرس 
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Abstract
Parapneumonic effusion effusions are seen in at least 40% of patients with pneumonia. Despite recent progress in antibiotic therapy, Empyema remains a common clinical entity with considerable morbidity and mortality. Diabetes, immunosuppression, alcoholism, cancer, poor dental hygiene, and a greater pneumonia severity index are all risk factors for parapneumonic effusion.
A bacterial invasion of the pleura causes complicated parapneumonic effusions. The glucose level is low in this type of parapneumonic effusion, and the pleural fluid pH is less than 7.20. Negative cultures could be attributed to either rapid bacterial clearance from pleural space or a low bacterial count. The fluid is classified as complicated because it requires drainage to be resolved.
There are several options for treating parapneumonic effusion, including observation, therapeutic thoracentesis, tube thoracostomy, intrapleural fibrinolytics, medical thoracoscopy, thoracotomy with decortication, and open drainage procedures.
Fibrinolytic therapy reduces viscosity, breaks up loculations and pleural peel, improves pleural sepsis, and reduces the referral for surgical intervention .Medical thoracoscopy allows for the mechanical removal of infected material and the re-expansion of the lungs. Multiple loculations can be opened and the purulent liquid aspirated, removing the fibrinous adhesions, including the layer on the visceral pleura.
Forty patients with complicated parapneumonic effusion were recruited and informed consent was taken before the beginning of the study. The subjects were randomly assigned into two groups.