Approximately 50,000 patients annually develop parapneumonic effusions in Germany. These effusions are of prognostic significance in pneumonia. Thus urgent diagnosis by imaging procedures and diagnostic thoracentesis is indicated. Based on diagnostic criteria, parapneumonic effusions can be classified as uncomplicated and complicated effusions and finally pleural empyema. Management strategies include the administration of broad-spectrum antimicrobial therapy covering gram-positive, gram-negative and anaerobic bacteria and the sufficient drainage of the infected pleural fluid. Adequate drainage procedures include thoracentesis, chest tube insertion, application of local fibrinolytics and thoracic surgery. Their application should be selected after individual risk stratification including the assessment of the pleural space anatomy and appearance as well as microbiological and biochemical analysis of the pleural fluid.