Images in Clinical Medicine

Effect of Intrapleural Streptokinase on a Loculated Malignant Pleural Effusion

N.A. Maskell, M.R.C.P., and F.V. Gleeson, F.R.C.R., F.R.C.P.

N Engl J Med 2003; 348:e4April 3, 2003

• Slide

Article

Video

Ultrasonographic Images Before and After Treatment.

A 62-year-old woman with metastatic breast carcinoma presented with shortness of breath due to a left-sided malignant pleural effusion. A catheter placed in the pleural cavity failed to drain more than 250 ml of fluid over a 24-hour period. Ultrasonographic examination showed that numerous fibrinous septa were preventing drainage (Panel A and Video A). A 500,000-unit dose of streptokinase was instilled intrapleurally, and repeated ultrasonograms in the same position were obtained. Panel B and Video B show the ultrasonographic images 90 minutes after drug administration. After this single administration of streptokinase, an additional 1500 ml drained over the next 15 hours, with good lung reexpansion. The patient went on to undergo talc-slurry pleurodesis, which successfully controlled the effusion. These images document the action of streptokinase in breaking down fibrinous septae in a patient with a loculated malignant effusion. IVC denotes inferior vena cava.

N.A. Maskell, M.R.C.P.
F.V. Gleeson, F.R.C.R., F.R.C.P.
Churchill Hospital, Headington, Oxford OX3 7LJ, United Kingdom

Citing Articles (4)

Citing Articles

1. 1

   Najib M. Rahman, Fergus V. Gleeson. 2011. Lung, pleura and chest wall. , 1005-1021.
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2. 2

   Li-Han Hsu, Thomas C. Soong, An-Chen Feng, Mei-Ching Liu. (2006) Intrapleural Urokinase for the Treatment of Loculated Malignant Pleural Effusions and Trapped Lungs in Medically Inoperable Cancer Patients. Journal of Thoracic Oncology 1:5, 460-467
   CrossRef

3. 3

   Maskell, Nicholas A., Davies, Christopher W.H., Nunn, Andrew J., Hedley, Emma L.Gleeson, Fergus V., Miller, Robert, Gabe, Rhian, Rees, Glyn L.Peto, Timothy E.A., Woodhead, Mark A., Lane, Donald J., Darbyshire, Janet H., Davies, Robert J.O., . (2005) U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection. New England Journal of Medicine 352:9, 865-874
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4. 4

   L. R. ZACHARSKI, V. P. SUKHATME. (2005) Coley's toxin revisited: immunotherapy or plasminogen activator therapy of cancer?. Journal of Thrombosis and Haemostasis 3:3, 424-427
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