Treatment of loculated pleural effusion with intrapleurally urokinase in children

Loculated pleural efiusion may become resistant to simple chest tube drainage. The treatment of such compartmental organization may require surgical intervention such as thoracotomy with septal division or even decortication. Recently, intrapleural fibrinolytic treatment has been suggested in adults. We report two children aged (Figure Presented) 11 years and 12 years, with massive and multiloculated pleural effusions in whom repeated closed chest drainage (including ultrasound guided) failed only minimal amounts of fluid drained. In both cases, urokinase (UK) 100,000 U in 100 ml normal saline was instilled into the pleural space via a chest tube, which was then clamped. After 12 Patient Ko. 1: Daily pleural drainage before and hours the tube was reopened and a during UK neatment large amount of fluid drained (600 ml for patient 1 and 280 ml for patient 2). This treatment was repeated daily for 5 days (Figure) with complete resolution of the pleural effusion in both cases. Coagulation studies were unchanged and no complications were observed. We suggest that intrapleural UK should be used in cases of persistent loculated pleural effiision before surgical intervention is undertaken. This therapy is safe, cost effective and may decrease the need for thoracotomy.