TRANSCATHETER INSTILLATION OF UROKINASE INTO LOCULATED PLEURAL EFFUSION - ANALYSIS OF TREATMENT EFFECT

OBJECTIVE. Our objective was to evaluate the usefulness of intracavita ry instillation of urokinase in the treatment of loculated pleural eff usion. SUBJECTS AND METHODS. We analyzed CT and sonographic scans of 3 1 patients with loculated pleural effusion treated with intracavitary urokinase. When the drainage was less than 100 ml/day, urokinase was i nstilled through the catheter until the drainage was less than 50 ml/d ay. Response to the treatment was assessed on follow-up chest radiogra phs and classified into three groups: completely effective (lung expan sion >80%), partially effective (20-80%), and ineffective (<20%). The sonographic pattern of pleural fluid was classified as anechoic, linea r septated, or honeycomb, and the thickness of the parietal pleura was measured on CT scans. RESULTS. Of the 16 patients in whom treatment w as completely effective, sonography showed an anechoic appearance in 1 2 and a linear septated appearance in four, and the thickness of the p arietal pleura on CT scans was 2 mm in six, 3 mm in seven, and 4 mm in three. Of the nine patients in whom treatment was partially effective , sonography showed an anechoic appearance in six and a linear septate d appearance in three, and the thickness of the parietal pleura on CT scans was 3 mm in five and 4 mm in four. Of the six patients in whom t reatment was ineffective, sonography showed a linear septated appearan ce in one and a honeycomb appearance in five, and the thickness of the parietal pleura on CT scans was 3 mm in one, 4 mm in two, 5 mm in one , and 6 mm in two. CONCLUSION. Urokinase instillation through a percut aneous catheter was effective in the treatment of loculated pleural ef fusion in most patients but was not effective in patients whose pleura l fluid had a honeycomb appearance on sonography or whose parietal ple ura had a thickness of more than 5 mm on CT scans.