Objective: To assess the incidence of necrotizing pneumonia (NP) in children submitted to thoracoscopy, comparing patients with and without NP in terms of the presentation and clinical evolution. Methods: A retrospective study of children with pleural empyema submitted to thoracoscopy. Thoracoscopy was performed in patients not previously submitted to thoracic drainage and in whom there was evidence of loculated effusion or pneumothorax, as well as in those previously submitted to thoracic drainage and in whom there was persistent pneumothorax or fever with purulent discharge. On the basis of the thoracoscopy findings, patients were distributed into two groups: those with NP (NP group) and those without (no-NP group). Results: The study sample comprised 52 patients. Of the 24 patients with NP, 19 (79%) had undergone thoracic drainage prior to thoracoscopy, 11 (46%) presented with pneumothorax, and 16 (67%) developed bronchopleural fistula. In the NP group, the median drainage time and the median length of hospital stay were 18 and 19 days, respectively. Of the 28 patients without NP, 10 (36%) had undergone thoracic drainage prior to thoracoscopy, 9 (32%) presented pneumothorax, and 5 (18%) developed bronchopleural fistula. In the no-NP group, the median drainage time and the median length of hospital stay were 6 and 10 days, respectively. Conclusions: Pneumothorax should raise the suspicion of NP. Early thoracoscopy can be a valuable treatment option for NP in children because it hastens recovery in comparison with the medical treatment alone and avoids extensive late thoracotomy lung resections.Keywords: Empyema, pleural; Thoracoscopy; Pneumonia; Child. ResumoObjetivo: Analisar a incidência de pneumonia necrosante (PN) em crianças submetidas a toracoscopia e comparar pacientes com e sem PN em relação às diferentes apresentações e evolução clínica. Métodos: Estudo retrospectivo de crianças portadoras de empiema e submetidas a toracoscopia. A toracoscopia foi realizada em pacientes não submetidos a drenagem torácica prévia e evidência de derrame septado ou pneumotórax, assim como naqueles submetidos previamente a drenagem torácica e pneumotórax persistente ou febre e secreção purulenta. Baseado na presença de PN durante a toracoscopia, os pacientes foram divididos em dois grupos: com PN e sem PN. Resultados: Participaram do estudo 52 pacientes. Dos 24 pacientes com PN, 19 (79%) foram submetidos a drenagem torácica anterior à toracoscopia, 11 (46%) apresentaram pneumotórax, e 16 (67%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo de drenagem e de hospitalização foram, respectivamente, 18 e 19 dias. Dos 28 pacientes sem PN, 10 (36%) foram submetidos a drenagem torácica anterior à toracoscopia, 9 (32%) apresentaram pneumotórax, e 5 (18%) evoluíram com fístula broncopleural. Neste grupo, as medianas do tempo médio de drenagem e de hospitalização foram, respectivamente, 6 e 10 dias. Conclusões: A PN deve ser suspeitada na presença de pneumotórax. A toracoscopia precoce pode ser uma opç...