Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase.
OBJECTIVE
We report the results of image-guided catheter drainage with adjunctive enzymatic pleural debridement in the treatment of empyemas and other complicated pleural fluid collections.


METHODS
Retrospective review.


METHODS
One hundred eighteen patients with complicated pleural fluid collections were treated with image-guided drainage. There were 79 empyemas, 27 sterile loculated parapneumonic effusions, 10 sterile hemothoraces, and 2 sterile postoperative exudative effusions. Forty-one patients had failed prior large-bore thoracostomy drainage. The estimated age of the effusions at the time of image-guided drainage ranged from 1 to 175 days with a mean estimated age of 13 days.


METHODS
Patients were treated with image-guided placement of one or more 12F to 16F chest drains. Adjunctive urokinase instillation was used in 98 cases. Urokinase (100,000 to 250,000 U/mL) was instilled in 20 to 240-mL aliquots and reaspirated in 1 to 4 h. One to four instillations were performed per day until drainage was complete.


RESULTS
Drainage was successful in 111 cases (94%). Two patients died of sepsis with incomplete drainage. Five patients underwent decortication (three recovered and two died postoperatively). Fifty-three patients (45%) required placement of more than one drain. The mean duration of drainage was 6.3 days. Patients treated with pleurolysis required a mean of five instillations of urokinase. The mean total dose of urokinase used per case was 466,000 U. There were no complications.


CONCLUSIONS
Image-guided drainage with adjunctive pleural urokinase therapy is a safe and effective method of closed thoracostomy drainage of complicated pleural fluid collections and can obviate surgery in most cases.
Moulton
J S
JS
Department of Radiology, St. Anthony Hospital, Denver, CO 80204, USA.
Benkert
R E
RE
Weisiger
K H
KH
Chambers
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002648:Child; D003131:Combined Modality Therapy; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013907:Thoracostomy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator