Background: Pleural infection represents a significant burden of disease to patients and healthcare system, due to substantial morbidity and mortality worldwide, without a definite consensus on the optimal treatment approach and relative outcomes Objectives: To assess type and timing of first-line interventions and clinical outcomes of patients with pleural infection Methods: Patients hospitalized with a diagnosis of pleural infection from 2015 to 2020 are included in this, ongoing, multi-center retrospective study, involving tertiary hospitals across Italy. The following data are collected: clinical features, including effusion aspect, type and timing of first-line treatment (aspiration, drainage and size; medical thoracoscopy-MT; surgery), surgery referral, length of hospital stay, 30-day mortality Results: To date, data from 182 patients (4 centres) have been collected. MT was most frequent first-line approach (41%), followed by chest drain (16%; prevalence of large bore tube), thoracentesis (9%) and surgery (9%). Two thirds (69%) of interventions were performed within the first 48 hours. A subsequent surgery referral was needed in 10% of patients and was most frequent in chest drain subgroup as compared to MT one. Hospital stay was 11.7, 11.4 and 22.5 days in patients who never underwent surgery, who underwent surgery at onset and who underwent second-line surgery, respectively (p<0.01). Mortality at 30-day was 2% Conclusions: Our preliminary data showed that MT was the most common approach to pleural infections, although first-line management was heterogenic. Short-term clinical outcomes were overall favourable, but likely influenced by timely intervention and high level expertise of centres

The detection of foreign bodies in the pleural cavity is rare and mostly consequent to iatrogenic or traumatic events. The migration of an inhaled foreign body from the airways to the pleural space through a bronchopleural fistula is an exceptional event. We report a case of a pleural empyema consequent to an inhaled wooden skewer. CT scan and bronchoscopy were unable to identify the foreign body, due to its migration in the peripheral airways. The thin and pointed foreign body perforated the visceral pleural surface emerging in the pleural cavity.