Lung ultrasonography is an essential tool in the management of pleural infection. We report the usage of lung point-of-care ultrasound (POCUS) using a handheld ultrasound system (HHUS), which changed the immediate management of a complex pleural effusion.A middle-aged diabetic patient presented with fever, dyspnoea and left-sided pleuritic chest pain, suggestive of left pleural infection. Lung POCUS using a HHUS showed a multiloculated pleural effusion with no connections between the locules, and this was confirmed later with CT, along with left empyema necessitans. An upfront video-assisted thoracoscopy was done instead of catheter drainage and intrapleural enzyme therapy. Methicillin-sensitive