الفهرس 
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Abstract
Parapneumonic effusion is defined as an exudative pleural effusion that can complicate pneumonia. It can present in 3 phases: the exudative phase (simple effusion), the fibrinopurulent phase, which is characterized by the deposition of fibrin and loculations, and the Organization phase is characterized by pleural peel limiting lung inflation.
Clinical presentation can vary from fever, loss of appetite, cough, and chest pain up to septic shock. There is an increase in the inflammatory markers - including white blood cells (WBCs) and C-reactive protein (CRP). Chest X-rays usually show obliteration of the costophrenic angle and meniscus sign and may show mediastinal shift and/or scoliosis. Ultrasound scan is usually a preferred modality. It confirms the diagnosis, detects loculations, and determines the optimum spot for chest tube insertion.
As parapneumonic effusion can occur in different phases with a variable rate of progression between the phases. There are different treatment modalities for the corresponding phases ranging from supportive measures, antibiotics, chest drain, fibrinolytics, VATS, and thoracotomy.
The optimum time and type of drainage and surgical intervention remain controversial.
We performed a retrospective study aiming to compare the outcome between primary chest drain and fibrinolytic therapy and primary VATS in the management of paediatric empyema patients. We also tried to identify factors affecting this outcome.