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pleural thickening might also be diagnosed on the basis of CT scans.Compared with pulmonary actinomycosis, the bacteriologic diagnosis is easily obtained by means of thoracocentesis in case of pleural involvement. However, diagnosis might be obscured by previous antibiotic therapy and a lack of anaerobic conditions for culture. At direct microbiologic examination, actinomycosis has to be suspected if gram-positive filamentous germs are discovered. An anaerobic enriched environment is needed for appropriate culture.Penicillin G still remains the drug of choice, and the mainstay of treatment is the administration of high-dose intravenous penicillin. Eighteen to 24 millions units of penicillin per day are given for 2 to 6 weeks, followed by oral penicillin V administration for another 6 to 12 months. The evolution should be monitored by use of plain radiographs or CT.In stage I empyema, indication for surgical intervention is uncommon, but the efficacy of antibiotic therapy depends on the onset of diagnosis. If the treatment is delayed, stage II and III empyemas can develop, and decortication is required. Chest-wall fistulization has to be resected during the intervention. A VATS approach is usually unrewarding because of the chronicity of empyema at the time of the operation. After the operation, penicillin administration is recommended.