Intrapleural instillation of thrombolytic agents has been useful in th
e treatment of hemothorax when thoracostomy tube drainage is unsuccess
ful. We present a patient who developed acute hypoxemic respiratory fa
ilure following the intrapleural instillation of both streptokinase an
d urokinase 24 h apart. Hypoxemia most likely resulted from a direct e
ffect of the products of fibrinolysis on the pulmonary circulation.