A case of fibrinopurulent empyema effectively treated with intrapleural urokinase following debridment by thoracoscopy under local anesthasia

A 71-year-old man was referred to our hospital for the treatment of right pleural effusion. Pleural effusion was exudative and Streptococcus constellatus was detected. Although he was treated with antibiotic therapy and chest-tube drainage, the initial treatment was unsuccessful. Thoracoscopy under local anesthesia was performed for the debridement of empyema and the replacement of the chest tube. The next day, intrapleural instillation of Urokinase was started, and Urokinase was given daily through the chest tube at a dose of 60,000 U. Three days later pleural effusion had disappeared. This case suggests that the combination therapy of thoracoscopic debridement and intrapleural Urokinase may be an effective treatment in patients with fibrinopurulent empyema. Further analyses of this technique, including a prospective controlled trial, are necessary.