Complicated parapneumonic effusion and empyema: pleural decortication and video-assisted thoracic surgery.

Complicated parapneumonic effusion or empyema, in which the fluid becomes more exudative, develops in 10% to 20% of patients with parapneumonic effusions. Early diagnosis and effective treatment strategies are required. New treatment strategies such as fibrinolytic therapy and decortication or debridement through video-assisted thoracoscopic surgery, have changed the choice of treatment for different stages of empyema or complicated pleural effusion. This review discusses the definition, clinical presentations, diagnosis, and treatment of these conditions, focusing on the value and comparison of video-assisted thoracoscopic surgery decortication and fibrinolytic therapies.