Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report
Introduction: Pleural effusion drainage in addition to antibiotics is used for the management of empyema and complex parapneumonic effusions (CPE). Fibrinolytics aid in drainage because fibrin adhesions create loculations in the pleural space. Although open thoracotomy and video-assisted thoracoscop...
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Jaypee Brothers Medical Publisher
2024-09-01
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| Series: | Indian Journal of Respiratory Care |
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| Online Access: | https://www.ijrc.in/doi/IJRC/pdf/10.5005/jp-journals-11010-1135 |
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| author | Rhea P Gandhi Sachinkumar S Dole M S Barthwal |
| author_facet | Rhea P Gandhi Sachinkumar S Dole M S Barthwal |
| author_sort | Rhea P Gandhi |
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| description | Introduction: Pleural effusion drainage in addition to antibiotics is used for the management of empyema and complex parapneumonic effusions (CPE). Fibrinolytics aid in drainage because fibrin adhesions create loculations in the pleural space. Although open thoracotomy and video-assisted thoracoscopic surgery (VATS) are the best therapeutic modalities, their widespread use is limited by operational risk and increased costs. Thus, intrapleural fibrinolytic therapy (IPFT) must be considered before more expensive and invasive techniques.
Case description: We present a case of a 10-year-old girl who presented with fever, dry cough, and loss of appetite for 2 weeks along with breathlessness for 1 week. Her chest radiograph revealed left-sided massive pleural effusion for which left tube thoracostomy was done. It was a tubercular, exudative lymphocytic effusion. The patient was advised to undergo thoracic surgery in the form of VATS with thoracotomy for failed tube drainage. Instead of subjecting her to an expensive and major surgical procedure, she was subjected to IPFT with three doses of streptokinase. There was complete resolution of the loculated pleural effusion, and she was discharged after 3 days.
Conclusion: Regardless of the etiology, IPFT is an affordable option for all kinds of loculated pleural collections and needs to be presented as the first choice, even when VATS is available. |
| format | Article |
| id | doaj-art-ce698673819b40d09cedbfadb916f3fb |
| institution | DOAJ |
| issn | 2277-9019 2321-4899 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Jaypee Brothers Medical Publisher |
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| series | Indian Journal of Respiratory Care |
| spelling | doaj-art-ce698673819b40d09cedbfadb916f3fb2025-08-20T03:17:58ZengJaypee Brothers Medical PublisherIndian Journal of Respiratory Care2277-90192321-48992024-09-0113321221510.5005/jp-journals-11010-113514Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case ReportRhea P Gandhi0Sachinkumar S Dole1M S Barthwal2Department of Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, IndiaSachinkumar S Dole, Department of Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, Phone: +91 9637104972Department of Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, IndiaIntroduction: Pleural effusion drainage in addition to antibiotics is used for the management of empyema and complex parapneumonic effusions (CPE). Fibrinolytics aid in drainage because fibrin adhesions create loculations in the pleural space. Although open thoracotomy and video-assisted thoracoscopic surgery (VATS) are the best therapeutic modalities, their widespread use is limited by operational risk and increased costs. Thus, intrapleural fibrinolytic therapy (IPFT) must be considered before more expensive and invasive techniques. Case description: We present a case of a 10-year-old girl who presented with fever, dry cough, and loss of appetite for 2 weeks along with breathlessness for 1 week. Her chest radiograph revealed left-sided massive pleural effusion for which left tube thoracostomy was done. It was a tubercular, exudative lymphocytic effusion. The patient was advised to undergo thoracic surgery in the form of VATS with thoracotomy for failed tube drainage. Instead of subjecting her to an expensive and major surgical procedure, she was subjected to IPFT with three doses of streptokinase. There was complete resolution of the loculated pleural effusion, and she was discharged after 3 days. Conclusion: Regardless of the etiology, IPFT is an affordable option for all kinds of loculated pleural collections and needs to be presented as the first choice, even when VATS is available.https://www.ijrc.in/doi/IJRC/pdf/10.5005/jp-journals-11010-1135case reportintrapleural fibrinolytic therapyloculated effusionstreptokinasevideo-assisted thoracoscopic surgery |
| spellingShingle | Rhea P Gandhi Sachinkumar S Dole M S Barthwal Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report Indian Journal of Respiratory Care case report intrapleural fibrinolytic therapy loculated effusion streptokinase video-assisted thoracoscopic surgery |
| title | Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report |
| title_full | Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report |
| title_fullStr | Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report |
| title_full_unstemmed | Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report |
| title_short | Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report |
| title_sort | intrapleural fibrinolytic therapy in pediatric loculated pleural effusion a case report |
| topic | case report intrapleural fibrinolytic therapy loculated effusion streptokinase video-assisted thoracoscopic surgery |
| url | https://www.ijrc.in/doi/IJRC/pdf/10.5005/jp-journals-11010-1135 |
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