Empyema is an uncommon complication of childhood pneumonia, occurring in approximately 0.7- 3.3% per 100,000 worldwide [1-3] <#_ENREF_3> . Although mortality rates in paediatric empyema are very low in developed nations, empyema causes significant morbidity including substantial health care costs and burden of care. Many treatment options are available but due to a lack of quality research there is limited high grade evidence to direct best standards of care. The need for local guidelines was highlighted in a recent survey of clinical management practices in Australia which demonstrated that a wide range of interventions were used and that there is a lack of consensus in the management of paediatric empyema. This is certainly evident even within RCH Melbourne where children with empyema are commonly seen around our wards, managed by different teams adopting significant practice variation. Furthermore, the study also demonstrated that paediatric empyemas are occasionally treated in smaller hospitals without paediatric specialists. The aim of this Grand Round is:

• To increase understanding of the pathophysiology of pleuritis and empyema

• To present new data on the changing epidemiology of childhood empyema

• To review our knowledge on the investigation and diagnosis of pleuritis and empyema

• To discuss the treatment controversies and the pros and cons associated with different clinical management practices (the fuss about pus)

• To review national guidelines for the management of empyema