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 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.