Treatment ofComplicated Pleural Fluid Collections WithImage-Guided Drainage andIntracavitary Urokinase*

debridment inthetreatment ofempyemas andother complicated pleural fluid collections. Design: Retrospective review. Patients: Onehundred eighteen patients withcompli¬ catedpleural fluid collections were treated withim¬ age-guided drainage. There were 79empyemas, 27 sterile loculated parapneumonic effusions, 10sterile hemothoraces, and2sterile postoperative exudative effusions. Forty-one patients hadfailed prior largeborethoracostomy drainage. Theestimated ageofthe effusions atthetimeofimage-guided drainage ranged from1to175days with a mean estimated ageof13 days. Patients were treated withimage-guided placement ofone or more 12Fto16Fchest drains. Adjunctive urokinase instillation was usedin98cases. Urokinase (100,000 to250,000 U/mL) was instilled in 20to240-mLaliquots andreaspirated in1to4h.One tofourinstillations were performed perday until drainage was complete. Measurements andresults: Drainage was successful in 111cases (94%). Twopatients diedofsepsis with incomplete drainage. Fivepatients underwent decor¬ tication (three recovered andtwodiedpostoperative¬ ly). Fifty-three patients (45%) required placement of more than one drain. Themean duration ofdrainage was 6.3days. Patients treated withpleurolysis required a mean offive instillations ofurokinase. Themean to¬ taldoseofurokinase usedpercase was 466,000 U. There were no complications. Conclusion: Image-guided drainage withadjunctive pleural urokinase therapy isa safeandeffective methodofclosed thoracostomy drainage ofcompli¬ cated pleural fluid collections andcan obviate surgery inmostcases. (CHEST 1995; 108:1252-59)