Abstract
Background: Loculated pleural effusion is one of the most common clinical entities which are usually caused by empyema, tubercular pleural effusion, malignancy, and hemothorax. The role of Intra-pleural Fibrinolytic Therapy (IPFT) with various fibrinolytics has been studied, however its clinical, radiological and functional outcomes are not assessed completely. Objective: This is a pre and post intervention study conducted at tertiary care hospital to assess the role of IPFT with streptokinase in patients with loculated pleural effusion. Results: 102 patients underwent IPFT with streptokinase. Out of 102 patients, 84 patient were male and 18 were females. Main preprocedure diagnosis were tuberculosis (n=70), pneumonia (n=21) and malignancy (n=11). The patients were subdivided into three groups based on sonologically assessed amount of intrapleural fluid - Group 1 (200ml). During pre and post IPFT procedure the number of patients identified in group 1 were 30 and 80, group 2 were 40 and 22, group 3 were 32 and none respectively. The mean residual pleural fluid drained before and after IPFT were 190.80ml and 57.84ml (p value Conclusion: IPFT with streptokinase is a safe option in loculated pleural effusion with no major adverse effects. Keywords: Intrapleural Fibrinolytic Therapy, Loculated pleural effusion, Fibrinolytics.
Highlights
Loculated pleural effusions are a common sequelae of complicated parapneumonic effusions and empyema followed by tubercular pleural effusions, haemothorax and malignant effusions
4 early use of fibrinolytic agents in loculated pleural effusion will result in breaking of loculi and increasing pleural space drainage. 2,3 The BTS guidelines have recommended consideration of intrapleural fibrinolytics in failed drainage in complicated parapneumonic effusion and empyema. 5
A total of 102 patients admitted to the tertiary care centre who had radiologically proven loculated pleural effusion were enrolled in the study
Summary
Loculated pleural effusions are a common sequelae of complicated parapneumonic effusions and empyema followed by tubercular pleural effusions, haemothorax and malignant effusions. Loculations develop due to delayed initiation and inadvertent use of antibiotics and due to prolonged pleural effusion in the setting of inflammation due to various causes. This results in fibrosis in the pleural cavity leading to pleural thickening and loss of pulmonary function in due course. The initial two treatment modalities are not so effective in removal of pleural fluid.[3]. Objective : This is a pre and post intervention study conducted at tertiary care hospital to assess the role of IPFT with streptokinase in patients with loculated pleural effusion. Conclusion: IPFT with streptokinase is a safe option in loculated pleural effusion with no major adverse effects
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