Introduction:Pediatric empyema thoracis remains a significant healthcare challenge, particularly in developing countries where delayed diagnosis and inadequate initial management lead to increased morbidity. The condition, characterized by the presence of pus in the pleural cavity, often arises as a complication of bacterial pneumonia. Despite advancements in imaging and antibiotic therapy, variability in clinical presentations and treatment responses necessitates further evaluation of its epidemiological, pathological, and radiological characteristics. This study aims to analyse the clinical, microbiological, and radiological features of pediatric empyema thoracis to optimize diagnostic and therapeutic approaches. Materials and Methods: A retrospective study was conducted at KIMS Hospital, Kurnool, Andhra Pradesh, from 2020 to 2022, involving 50 pediatric empyema cases. Data were collected from medical records department (MRD), including demographic details, clinical symptoms, laboratory investigations, microbiological findings, radiological assessments, treatment modalities, and outcomes. Pleural fluid analysis, bacterial cultures, and antibiotic sensitivity testing were performed. Radiological evaluation included chest X-ray and high-resolution computed tomography (HRCT) when required. Treatment approaches consisted of intercostal tube drainage (ICT) with antibiotics, with surgical intervention performed in selected cases. Results: Most cases (58%) were in the 3–5-year age group, with a male predominance (70%). Fever (100%) and cough (70%) were the most common symptoms. Staphylococcus aureus was the most frequently isolated pathogen (24%), followed by Streptococcus pneumoniae (16%). Radiological findings showed pleural effusion in all cases (100%), with consolidation in 58%. Treatment involved ICT with antibiotics in 40% of cases, while 60% required additional surgical intervention. Conclusion: Pediatric empyema thoracis remains a significant clinical entity with diverse microbiological profiles and radiological patterns. Early diagnosis, guided by imaging and microbiological analysis, is crucial for effective management. A multimodal approach, including antibiotics, pleural drainage, and surgical intervention, when necessary, is essential for optimizing outcomes.