Objective: Pleural effusions are a frequent
complication of malignancy and cause considerable morbidity from
dyspnea. The drainage and control of malignant effusions relieve
symptoms and maintain quality of life but these are difficult in
patients with multiloculated effusions in whom drainage usually fails.
This observational series reports the use of intrapleural streptokinase
(IPSK) in the management of malignant multiloculated pleural effusions
resistant to standard chest tube drainage.
Ten consecutive patients with malignant multiloculated pleural
effusions, aged 39 to 89 years, were given 250,000-IU doses of IPSK
twice daily after failure to drain the effusions with a standard chest
tube because of multiloculation and multiseptation, as demonstrated by
CT or ultrasound scanning. Outcome was assessed by radiographic
improvement and symptom control.
Results: All 10
patients responded to between 500,000 and 1,500,000 IU of
streptokinase. There was an increase in pleural fluid drained (mean
volume ± SD; pre-IPSK, 843 ± 690 mL; post-IPSK, 2,368 ± 1,051
mL; p < 0.001, paired t test), and radiographic
improvement was seen in all 10 patients. All subjects tolerated the
instillation of streptokinase well. One subject required opiate
analgesia for transient chest pain, and there were no hemorrhagic or
allergic complications. One patient died of unrelated septicemia.
Conclusions: This series suggests that IPSK may be useful
in the drainage of malignant multiloculated pleural effusions in
patients who fail to drain adequately with a standard chest tube.
Malignant pleural effusions should not be considered a contraindication
Abbreviations: IPSK = intrapleural streptokinase