Parapneumonic effusion (PPE) and empyema are most often seen as acomplication of bacterial pneumonia and occasionally associated with atypicalbacteria or viruses. The aims of this study were to describe and comparedemographic characteristics, clinical, laboratory, microbiological findings andtreatment modalities of patients with PPE and empyema. We retrospectivelyreviewed 116 pediatric patients with PPE and empyema. Seventy (60.3%)had pleural empyema and 46 patients (39.6%) had PPE. The median age ofpatients with empyema [72.0 months (IQR 68.0 months)] was lower thanthe patients with PPE [92.5 (IQR 80.0 months)] (p=0.003). Children in theempyema group had significantly more dyspnea symptoms than the childrenwith PPE (p=0.022). Mean fever duration before hospitalization was similarin both groups. Streptococcus pneumoniae and group A streptococcus were themost common causes of empyema. All of the patients were treated withintravenous antibiotics. In addition to medical treatment, tube thoracostomywas performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%)of them required intrapleural fibrinolysis also. In the presence of antibiotictreatment failure or in cases with moderate or large pleural effusion withloculations and clinical deterioration; it is necessary to perform drainage ofthe purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics orto perform video-assisted thoracoscopic surgery (VATS), in order to enhanceprompt recovery.