Patients with large refractory pulmonary abscess cavities or pleural infection (empyema) represent specialized thoracic conditions that require the expertise of a thoracic surgeon. Lobectomies for abscesses represent challenging cases in thoracic surgery because of the extensive enlargement and adhesiveness of intrapulmonary lymph nodes. Empyema and decortication while traditionally treated via thoracotomy are now routinely treated thoracoscopically by Dr Sternberg. This represents a huge morbidity benefit to the patient who is already coping with serious infection and who is now spared a large rib spreading incision as well. These cases should only be approached by an experienced thoracic surgeon who is well versed in minimally invasive techniques and thoroughly familiar with intra-pulmonary vascular anatomy.