Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions.
OBJECTIVE
To assess the feasibility and effectiveness of intrapleural recombinant tissue-type plasminogen activator (r-tPA) in the treatment of loculated parapneumonic effusions (PPEs).


METHODS
A single-arm prospective study of 25 consecutive patients with loculated PPEs was analyzed. All patients received 6-mg doses of intrapleural r-tPA on a defined schedule via a thoracostomy tube. The volume of output from the tubes was recorded and analysis of the fluid composition performed. Follow-up was both clinical and radiographic, with all patients undergoing pre- and postprocedural computed tomography.


RESULTS
Eighteen of the 25 patients (72%) required no additional intervention and had a complete clinical and radiographic response with the fibrinolytic therapy. Seven patients (28%) were treated with video-assisted thoracoscopic surgery, but no patient required thoracotomy for total decortication. There were no hemorrhagic complications.


CONCLUSIONS
Intrapleural r-tPA is effective in the treatment of loculated PPEs. It can be performed safely and in some patients may avoid the need for additional surgical intervention.
Zuckerman
Darryl A
DA
Department of Radiology, University Hospital, Cincinnati, OH, USA. zuckermand@mir.wustl.edu
Reed
Michael F
MF
Howington
John A
JA
Moulton
Jonathan S
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D011014:Pneumonia / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator