The actual incidence of empyema thoracis is still increasing worldwide and remains a clinical challenge with significant impact on public health; early recognition and prompt evaluation are of prime importance. Despite a lack of standardization of treatments, management should be planned according to stage, avoiding delays on referral. Exudative empyema (stage I) should be treated by aspiration or tube thoracostomy. Fibrinopurulent empyema (stage II) can be treated effectively by video-assisted thoracic surgery. Debridement and decortication are the main components of surgical treatment of stage III empyema. It is worthwhile to assess most cases by video-assisted thoracoscopy.