To evaluate the indication of the use of intracavitary Urokinase(UK) in the treatment of loculated pleural effusion.
We analyzed CT and US and pleural fluid examination in 31 patients who were treated with intracavitary UK in loculated pleural effusion. When the amount of drainage was less than 100 ml/day, UK was instilled through the catheter until less than
50
ml/day. On at least 1 month follow-up chest radiograhs, we classified the results of treatment into 3 groups: (1) completely effective (lung expansion, over 80%), (2) partially effective (20-80), (3) ineffective (bellow 20%) group. sonographic
pattern
of pleural fluid was classified into anechoic, linear septated, and honeycomb appearanceds and the thickness of parietal pleura was measured on CT and Pleural fluid examination was performed and classified into transudate and exudate.
Sixteen patients were completely effective, nine were effective, and six were ineffective group, all patients of completely effective and partially effective patients had anechoic and linear septated appearance on US and had less than 4 mm of
parietal
pleural thickness on CT. Of six ineffective patients, US showed linear septatex in one patients and honeycomb appearance in five patients and the thickness of parietal pleura on CT was 3 mm in one patients, 4 mm in two patients, 5 mm in one
patient, and
6 mm in two patients. In peural fluid examination, all patients were classified into exudate.
UK instillation through percutaneous catheter was an effective method in the treatmetn of loculated pleural effusion. However, we found near complete reaccumulation of pleural fluid when honeycomb appearance of pleural fluid on US or more than 5
mm
parietal pleural thickness on CT were observed, which might suggest that we should consider the other kinds of treatment method in those patients.
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