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PEDIATRICS Vol. 111 No. 2 February 2003, pp. e188-e190

ELECTRONIC ARTICLE

Alteplase in the Treatment of Complicated Parapneumonic Effusion: A Case Report

The treatment of complex parapneumonic effusions in children remains controversial, with some advocating less invasive, strictly medical management and others supporting a more aggressive approach of thoracotomy with or without decortication. Recent advances, including video-assisted thoracoscopic surgery and intrapleural fibrinolytic therapy, offer new options for effective treatment. We report the first case of successful resolution of a complex parapneumonic effusion in a 16-month-old girl with the use of tissue plasminogen activator (alteplase), infused via a catheter in the pleural space.

Naomi B. Bishop, MD, Steven Pon, MD, H. Michael Ushay, MD, PhD and Bruce M. Greenwald, MD

From the New York Presbyterian Hospital, Weill Medical College of Cornell University, Division of Critical Care, Department of Pediatrics, New York, New York

Key Words: parapneumonic effusion • intrapleural fibrinolytic therapy • tissue plasminogen activator • alteplase

Abbreviations: t-PA, tissue plasminogen activator • WBC, white blood cell • CT, computed tomography (scan)

Received for publication May 14, 2002; Accepted Sep 19, 2002.


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