Objective: Fibrous cortex developes over the lung in 7-10 days if the benign or malign pleural effusion consisting of blood, coagulum or
empyema could not be drained. Thus, clinical conditions like trapped lung, restrictive lung disease, or dyspnea may appear as a result of
fibrinous pleuritis. Both streptokinase and tissue plasminogen activator (tPA) are involved in the breakdown of proteins and fibrin. Hence,
intrapleural fibrinolytic treatment (IPFT) may prevent invazive procedures by avoiding fibrous cortex develepment if it is applied at a proper
time.
Materials and Methods: Eighty five cases undergoing IPFT by tube or catheter thoracostomies between 2003-2013 are evaluated
retrospectively. Patients have been evaluated according to age, symptoms, diagnosis, and response to treatment.
Results: The mean age of the patients was 45.5 (65 males and 20 females). IPFT was performed in 30 patients with empyema, and in 20
and 13 patients due to postoperative or posttraumatic organised hematomas, respectively. Eleven patients underwent IPFT for loculated
benign pleural effusions while 9 patients recieved the treatment for loculated malign pleural effusions. Complicated hydropneumothorax
was the indication for IPFT in 2 patients. A total of sixty patients received tube thoracostomy while 25 patients underwent catheter
thoracostomy. Tree patients had decortication and 4 underwent video assisted thoracoscopic (VATS) drainage due to failure of IPFT.
Aseptic pleural space remained in 12 patients at the end of our study. One of the patients required blood transfusion and additional
medical treatment for intrapleural hemorrhage secondary to the local absorption of the IPFT.
Conclusion: IPFT is a safe, effective treatment which can be performed prior to much invasive surgical procedures in patients with
loculated empyema, clotted hemothorax, or postoperative hematoma, and benign or malign pleural effusions which can not be drained
due to high fibrinous contents.
Key words: Intrapleural; Streptokinase; Tissue Plasminogen Activator.
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