The introduction of antibiotics two decades ago made it appear that empyema would pass into history as a surgical and medical problem. However, there has been an increase in the incidence of childhood empyema in recent years. 1-3 Today, childhood empyema is a common complication of staphylococcal pneumonia; Koch and coworkers reported a 74% incidence of empyema in 83 cases of staphylococcal pneumonia in children. 4 Kevy and Lowe reported empyema associated with 10 of 11 cases of streptococcal pneumonia. 5 In spite of this increase in the incidence of childhood empyema, many surgeons who treat adult empyema are not familiar with the course of this disease in children. Empyema in children is almost always seen following a primary pulmonary infection. Since the introduction of antibiotics, empyema in adults is most often associated with malignancy or an operative procedure. In addition, the management and prognosis of childhood empyema differ from