[Drainage of loculated and/or multiloculated pleural effusions using a small caliber catheter and urokinase (pleuro-fibrinolysis)].

The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa, increased viscosity in pleural fluid and inappropriate placement of chest tubes. Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolytic agents to prevent the formation of septa and reduce the viscosity of pleural fluid. To assess our experience, the role and efficacy of administering intercavitary urokinase (UK) through a small caliber catheter (SCC) implanted with ultrasound guidance as part of the treatment for pleural effusions (PE) that are multiloculated and/or loculated. Fifty multiloculated and/or loculated PE were drained through a pig-tail type SCC between 8.2 and 10 F caliber inserted with ultrasound guidance. The criteria for prescribing the procedure were as follows: PE of any etiology with ultrasound confirmation of fibrin septa and/or multiloculation and absence of contraindication off UK administration. UK was given at a dose of 100,000 i.u. every two hours until disappearance of PE. Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolytic activity. The SCC was properly placed in all patients. UK administration was 366,000 i.u. and time the SCC were in place was 4.7 days. All PEs were initially drained completely. We examined the patients 30 days later, finding that PE had recurred in 2 (4%), resolution was complete and without sequelae in 8 (16%), nearly complete but with slight pleural thickening in 32 (64%) and partial with pleural opacities larger than 2 mm in 8 (16%). Use of SCC and UK (pleural fibrinolysis) is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time, prevents sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and/or multiloculation.