Download PDF
Semin intervent Radiol 2012; 29(04): 264-269
DOI: 10.1055/s-0032-1330060
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of Fibrinolytics in Abdominal and Pleural Collections

Anuradha S. Shenoy-Bhangle
1   Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital
,
Debra A. Gervais
1   Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital
2   Department of Pediatric Imaging Massachusetts General Hospital for Children, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Fluid collections that are incompletely drained despite adequate catheter position, size, and number represent a minority of abscesses but a source of great frustration for patients, surgeons, and interventional radiologists. Drainage of such complex collections is known to be more effective with the adjunctive use of intracavitary fibrinolytic agents instilled via the drainage catheter. In this review article, we discuss the role of fibrinolytics specifically tissue plasminogen activator as explored by interventional radiologists in enhancing effective drainage of these complex abdominal and pelvic collections as well as complex pleural collections.

Keywords

abscess - empyema - percutaneous drainage - thrombolytic therapy - interventional radiology
 

  • References

  • 1 Beland MD, Gervais DA, Levis DA, Hahn PF, Arellano RS, Mueller PR. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology 2008; 247 (2) 567-573
    CrossrefPubMedGoogle Scholar
  • 2 Zuckerman DA, Reed MF, Howington JA, Moulton JS. Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions. J Vasc Interv Radiol 2009; 20 (8) 1066-1069
    CrossrefPubMedGoogle Scholar
  • 3 Tillett WS, Sherry S. The effect in patients of streptococcal fibrinolysin (streptokinase) and streptococcal desoxyribonuclease on fibrinous, purulent and sanguinous pleural exudations. J Clin Invest 1949; 28 (1) 173-190
    CrossrefPubMedGoogle Scholar
  • 4 Moulton JS, Moore PT, Mencini RA. Treatment of loculated pleural effusions with transcatheter intracavitary urokinase. AJR Am J Roentgenol 1989; 153 (5) 941-945
    CrossrefPubMedGoogle Scholar
  • 5 Weinstein M, Restrepo R, Chait PG, Connolly B, Temple M, Macarthur C. Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions. Pediatrics 2004; 113 (3 Pt 1) e182-e185
    CrossrefPubMedGoogle Scholar
  • 6 Skeete DA, Rutherford EJ, Schlidt SA, Abrams JE, Parker LA, Rich PB. Intrapleural tissue plasminogen activator for complicated pleural effusions. J Trauma 2004; 57 (6) 1178-1183
    CrossrefPubMedGoogle Scholar
  • 7 Rahman NM, Maskell NA, West A , et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365 (6) 518-526
    CrossrefPubMedGoogle Scholar
  • 8 Gervais DA, Levis DA, Hahn PF, Uppot RN, Arellano RS, Mueller PR. Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology 2008; 246 (3) 956-963
    CrossrefPubMedGoogle Scholar
  • 9 Sugimoto K, Kee ST, Semba CP, Razavi MK, Sze DY, Dake MD. Safety and efficacy of tissue plasminogen activator to treat loculated pleural effusions. J Vasc Interv Radiol 2001; 12 (Suppl) S107
    PubMedGoogle Scholar
  • 10 Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology 2003; 228 (2) 370-378
    CrossrefPubMedGoogle Scholar
  • 11 Blom D, van Aalderen WM, Alders JM, Hoekstra MO. Life-threatening hemothorax in a child following intrapleural administration of urokinase [letter]. Pediatr Pulmonol 2000; 30 (6) 493
    CrossrefPubMedGoogle Scholar
  • 12 Lahorra JM, Haaga JR, Stellato T, Flanigan T, Graham R. Safety of intracavitary urokinase with percutaneous abscess drainage. AJR Am J Roentgenol 1993; 160 (1) 171-174
    CrossrefPubMedGoogle Scholar
  • 13 Diamond IR, Wales PW, Connolly B, Gerstle T. Tissue plasminogen activator for the treatment of intraabdominal abscesses in a neonate. J Pediatr Surg 2003; 38 (8) 1234-1236
    CrossrefPubMedGoogle Scholar