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Intrapleural Fibrinolysis for Parapneumonic Effusion and Empyema in Children¹

¹ From the Department of Radiology, MS 721, Children’s Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226 (R.G.W.); and Department of Pediatrics, MFRC, Medical College of Wisconsin, Milwaukee (P.L.H.). Received April 26, 2002; revision requested July 8; revision received October 4; accepted December 19. Address correspondence to R.G.W. (e-mail: rwells@chw.org).

View larger version (169K): [in a new window]   Figure a. Parapneumonic effusion in a 4-year-old boy with S pneumoniae pneumonia. (a) Anteroposterior left lateral decubitus radiograph obtained just prior to percutaneous thoracostomy tube placement shows left lung consolidation and a large pleural effusion. (b) Transverse US image of left lower portion of the chest shows multiple thin linear septations (arrows) within the pleural fluid. Only 10 mL of fluid was aspirated during tube placement. (c) Anteroposterior supine chest radiograph obtained the next day shows large residual pleural collection. A 14-F thoracostomy tube lies in the left posterior pleural space. A total of 50 mL of fluid had drained since tube placement. After intrapleural fibrinolysis with alteplase, 205 mL of fluid drained within 2 hours. (d) Anteroposterior supine chest radiograph obtained the next day shows marked interval decrease in pleural opacification and improved aeration of the left lung. Thoracostomy tube is in a stable position, and the J-loop has opened to its pre-formed shape.

View larger version (152K): [in a new window]   Figure b. Parapneumonic effusion in a 4-year-old boy with S pneumoniae pneumonia. (a) Anteroposterior left lateral decubitus radiograph obtained just prior to percutaneous thoracostomy tube placement shows left lung consolidation and a large pleural effusion. (b) Transverse US image of left lower portion of the chest shows multiple thin linear septations (arrows) within the pleural fluid. Only 10 mL of fluid was aspirated during tube placement. (c) Anteroposterior supine chest radiograph obtained the next day shows large residual pleural collection. A 14-F thoracostomy tube lies in the left posterior pleural space. A total of 50 mL of fluid had drained since tube placement. After intrapleural fibrinolysis with alteplase, 205 mL of fluid drained within 2 hours. (d) Anteroposterior supine chest radiograph obtained the next day shows marked interval decrease in pleural opacification and improved aeration of the left lung. Thoracostomy tube is in a stable position, and the J-loop has opened to its pre-formed shape.

View larger version (162K): [in a new window]   Figure c. Parapneumonic effusion in a 4-year-old boy with S pneumoniae pneumonia. (a) Anteroposterior left lateral decubitus radiograph obtained just prior to percutaneous thoracostomy tube placement shows left lung consolidation and a large pleural effusion. (b) Transverse US image of left lower portion of the chest shows multiple thin linear septations (arrows) within the pleural fluid. Only 10 mL of fluid was aspirated during tube placement. (c) Anteroposterior supine chest radiograph obtained the next day shows large residual pleural collection. A 14-F thoracostomy tube lies in the left posterior pleural space. A total of 50 mL of fluid had drained since tube placement. After intrapleural fibrinolysis with alteplase, 205 mL of fluid drained within 2 hours. (d) Anteroposterior supine chest radiograph obtained the next day shows marked interval decrease in pleural opacification and improved aeration of the left lung. Thoracostomy tube is in a stable position, and the J-loop has opened to its pre-formed shape.

View larger version (167K): [in a new window]   Figure d. Parapneumonic effusion in a 4-year-old boy with S pneumoniae pneumonia. (a) Anteroposterior left lateral decubitus radiograph obtained just prior to percutaneous thoracostomy tube placement shows left lung consolidation and a large pleural effusion. (b) Transverse US image of left lower portion of the chest shows multiple thin linear septations (arrows) within the pleural fluid. Only 10 mL of fluid was aspirated during tube placement. (c) Anteroposterior supine chest radiograph obtained the next day shows large residual pleural collection. A 14-F thoracostomy tube lies in the left posterior pleural space. A total of 50 mL of fluid had drained since tube placement. After intrapleural fibrinolysis with alteplase, 205 mL of fluid drained within 2 hours. (d) Anteroposterior supine chest radiograph obtained the next day shows marked interval decrease in pleural opacification and improved aeration of the left lung. Thoracostomy tube is in a stable position, and the J-loop has opened to its pre-formed shape.