Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience.
OBJECTIVE
We evaluate our experience in the management of empyemas and haemothoraces by means of intracavitary trans-catheter instillation of urokinase (UK).


METHODS
We reviewed 54 patients (44 men and 10 women) ranging in age from 12 to 86 years (average 56.3) admitted between May 1999 and April 2001 with loculated pleural effusions (45 empyemas and 9 haemothoraces) and treated by percutaneous drainage and intrapleural urokinase instillation. The criteria for withdrawal of the catheter were: ceased drainage or the drainage of <80-100 ml of clear liquid per day.


RESULTS
The duration of the drainage ranged from 2 to 15 days (average: 5.9). Total remission of symptoms occurred in 40 patients (74.07%); 7 patients presented a slight reduction in lung function tests (12.96%); 4 patients required surgery (7.4%); 3 displayed persistent pleural loculated effusions (5.55%) and 1 developed a bronchopleural fistula (1.85%); 2 patients were lost to our review (3.7%).


CONCLUSIONS
In our experience percutaneous drainage with intrapleural UK instillation is an effective approach to the management of loculated pleural effusions (empyemas and haemothoraces), able to obviate the need for other more invasive pulmonary interventions.
Basile
Antonio
A
Istituto di Radiologia, Policlinico G. Martino, Università degli Studi, Messina, Italy. antodoc@yahoo.com
Boullosa-Seoane
Esther
E
Dominguez Viguera
Luis
L
Certo
Antonio
A
Mundo
Elena
E
Garcia-Medina
José
J
Casal-Rivas
Moises
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D010994:Pleura; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator