Medical thoracoscopy versus intrapleural fibrinolytic therapy in complicated parapneumonic effusion and empyema

Aim: The aim of this study is to compare the therapeutic yield of medical thoracoscopy and intrapleural fibrinolysis by streptokinase in complicated parapneumonic effusion and empyema regarding both efficacy and safety. Patients and methods: This study included 40 inpatients with complicated parapneumonic effusion and empyema. Included patients had frank pus, pH< 7.20, positive Gram stain or culture. Patients were randomly divided into two groups; first group was managed by medical thoracoscopy (20 patients) and the second group was managed by intercostal tube drainage plus intrapleural instillation of streptokinase (20 patients). Patients who were diagnosed as tuberculosis, bronchial carcinoma, chronic obstructive airway diseases and uncompensated liver cell failure were excluded from the study. Clinical, laboratory, radiological data and hospital stay duration were adopted for comparison between two groups. Results: Comparing both groups, in group 1, 19 patients (95%) had total improvement and 1 patient (5%) had partial improvement, in group 2, 12 patients (60%) had total improvement and 6 patients (40%) had partial improvement in radiological end points which is statistically significant. The duration of hospital stay was 4.70 +/- 1.45 days in group 1 and 6.95 +/- 2.04 days in group 2 which is statistically significant. There were no serious complications, and no mortality in both groups. Conclusion: Medical thoracoscopy is superior to streptokinase fibrinolysis in complicated parapneumonic effusions and empyema in terms of safety and efficacy. (C) 2014 The Egyptian Society of Chest Diseases and Tuberculosis. Production and hosting by Elsevier B.V.