We describe our experience with the percutaneous drainage of empyemas in 20 patients, using fluoroscopic, computed tomographic or ultrasonic guidance for catheter placement. The patients were seen over a period of 17 months. Sixteen patients were successfully treated, with the empyema drained and the cavity closed. In four patients drainage was unsuccessful and surgery was required. In three of these patients there was a history of illness in excess of 4 weeks preceding treatment and in one a history of trauma. Two or more catheters were used in seven patients and positive microbiological culture of the pus was obtained in 12, although neither factor significantly altered prognosis. There were no complications of the procedure. We believe the percutaneous insertion of catheters using suitable imaging guidance should be the initial method of drainage of empyemas.