Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase

Chest. 1995 Nov;108(5):1252-9. doi: 10.1378/chest.108.5.1252.


Study objective: We report the results of image-guided catheter drainage with adjunctive enzymatic pleural debridement in the treatment of empyemas and other complicated pleural fluid collections.

Design: Retrospective review.

Patients: One hundred eighteen patients with complicated pleural fluid collections were treated with image-guided drainage. There were 79 empyemas, 27 sterile loculated parapneumonic effusions, 10 sterile hemothoraces, and 2 sterile postoperative exudative effusions. Forty-one patients had failed prior large-bore thoracostomy drainage. The estimated age of the effusions at the time of image-guided drainage ranged from 1 to 175 days with a mean estimated age of 13 days.

Interventions: Patients were treated with image-guided placement of one or more 12F to 16F chest drains. Adjunctive urokinase instillation was used in 98 cases. Urokinase (100,000 to 250,000 U/mL) was instilled in 20 to 240-mL aliquots and reaspirated in 1 to 4 h. One to four instillations were performed per day until drainage was complete.

Measurements and results: Drainage was successful in 111 cases (94%). Two patients died of sepsis with incomplete drainage. Five patients underwent decortication (three recovered and two died postoperatively). Fifty-three patients (45%) required placement of more than one drain. The mean duration of drainage was 6.3 days. Patients treated with pleurolysis required a mean of five instillations of urokinase. The mean total dose of urokinase used per case was 466,000 U. There were no complications.

Conclusion: Image-guided drainage with adjunctive pleural urokinase therapy is a safe and effective method of closed thoracostomy drainage of complicated pleural fluid collections and can obviate surgery in most cases.

Publication types

  • Multicenter Study
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chest Tubes
  • Child
  • Combined Modality Therapy
  • Drainage*
  • Empyema, Pleural / diagnostic imaging
  • Empyema, Pleural / drug therapy
  • Empyema, Pleural / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plasminogen Activators / therapeutic use*
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / drug therapy
  • Pleural Effusion / surgery
  • Pleural Effusion / therapy*
  • Retrospective Studies
  • Thoracostomy*
  • Thrombolytic Therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / therapeutic use*


  • Plasminogen Activators
  • Urokinase-Type Plasminogen Activator