Patients presenting for pleurectomy often have associated lung diseases such as asthma, emphysema and cystic fibrosis. Appropriate pre-operative optimizing of their condition should occur. One-lung anesthesia is required to assist access for pleurectomy procedure during which the pleura is stripped where possible. Although the commonest association of bacterial infection of the pleural space is a concomitant pneumonia, other causes include trauma or surgery to the thorax; and extension of a suppurative process from either neck or abdomen. Over half of patients presenting with empyema have concomitant chronic disease (for example, diabetes mellitus; malignancy) or conditions that predispose to aspiration pneumonia. The commonest set of operations for acquired chest wall disorders are those requiring chest wall resection. Chest wall resection requires careful operative planning including the extent of resection, the options for chest wall stabilization and the method of tissue coverage to be employed, usually a muscle flap.