Treatment of loculated pleural effusion with intrapleural urokinase in children

Abstract

The use of fibrinolytic agents such as urokinase and streptokinase has been reported in cases of empyema in adults. In pediatric patients the experience is, however, very limited. A series of seven consecutive children who had loculated pleural effusion that did not respond to drainage and antibiotics is reported. In all cases, the effusion was found to be multiloculated. Urokinase (UK) instillation through the already existing chest tube was started. A dose of 100,000 U of UK diluted in 100 mL of normal saline was instilled through the chest tube, which was clamped for 12 hours and then was left open for another 12 hours. In six of seven children, the treatment was terminated after complete or almost complete resolution was attained. This was achieved within 5 treatment days (mean, 3.3). There was one failure which was attributed to relatively late initiation of treatment. No complications were observed. The authors conclude that intrapleural administration of UK is a safe and efficient method of treatment in cases of loculated pleural effusions in children. UK instillation to the intrapleural space should be considered early before initiating surgical intervention. Starting intrapleural UK treatment should not be delayed.