Fibrinolysis treatment for loculated parapneumonic pleural effusion secondary to right lower lobe pneumonia.

The administration of fibrinolytic agents in the pleural cavity is an alternative treatment for the management of loculated empyemas in patients who are poor candidates for surgery and/or do not respond to more standard treatments (e.g., chest tube placement, pleurodesis). Unfortunately, in practice it is not frequently offered as an alternative treatment approach. Here we present the case of a 79-year-old male with right lower lobe pneumonia complicated by a parapneumonic pleural effusion that showed minimal improvement after chest tube placement and broad-spectrum antibiotic treatment. Intrapleural tissue plasminogen activator (tPA) was administered daily for three consecutive days, which resulted in the breakdown of intrapleural loculations and facilitation of drainage, followed by significant clinical and radiologic improvement. tPA was successful in the treatment of parapneumonic pleural effusions in a patient who was not a candidatefor surgical intervention and who failed to respond to standard treatments.