In infants and children, the empyema is usually associated with pneumonia. In the early period, antibiotics and chest tube drainage may be sufficient. But in the late stage of empyema, simple tube thoracostomy is inadequate. Surgical procedures of decortication and debridement are always intervened. Thoracoscopy is a good choice of procedure if the patient is still in the fibropurulent sage. We report a case of 4-year-old girl of stage II empyema. She received early thoracoscopy and decortication after the chest tube drainage was failure. The procedure was smooth and she was discharged 10 days afterwards. Conclusively, thoracoscopy is effective safe and gives better cosmetics for early empyema