Background: the recognition and treatment of retained haemothorax (RH) remains a significant problem. Conventionally these condition are managed surgically with open thoracotomy .Video-assisted thoracoscopic surgery (VATS)is an alternative surgical technique in evaluation of this condition . Methods: of the 318 patients admitted during the study period requiring or admitted with tube thoracostomy, there were 21 patients (6.6%) with RH. Intra-pleural installation of streptokinase 250000 IU daily for 5 days was started and then VATS was done for all cases. Failed VATS patients were requiring conversion to thoracotomy. Results: all patients were managed outside our hospital firstly, except one patient initially managed in our unit resulting in (0.31%) of residual haemothorax rate. There were 19 men and 2 women. 19 patients sustained blunt chest trauma and 2 patients sustained penetrating injury with failed attempts to drain with tube thoracostomy, thoracoscopic evacuation was successful in 16 patients (76.2%) and 5 patients requiring conversion to thoracotomy. Conclusion: videothoracoscopy is safe and effective procedure allowing successful treatment of up to (76.2%) of patients. Best results are obtained when drainage is performed within the first 5 days after trauma