Fibrinolysis Treatment for Parapneumonic Pleural Effusion with Intrapleural Tissue Plasminogen Activator / İntraplevral Doku Plasminojen Aktivatörüyle Parapnömonik Plevral Efüzyon için Fibrinoliz Tedavisi

Gürbüz Akçay, Nazile Ertürk, Aynur Köş, Arife Zeybek, Önder Yeniçeri

Özet


Abstract

Intrapleuritic fibrinolytic agent administration is an alternative treatment option in some patients. The ideal candidates include those who have an unfavourable general status for surgery or who fail to show adequate improvement despite standard therapy (e.g chest tube insertions, pleurodesis). Unfortunately, as an alternative treatment approach, fibrinolytic agent administration is not offered to patients as often as desired. In this paper, a seven-year-old male with parapneumonic pleural effusion following right lower lobe pneumonia was reported. The patient showed minimal improvement after insertion of a chest tube and administration of wide-spectrum antibiotic therapy whereas intrapleural loculations and septations persisted. Therefore, tissue plasminogen activator (tPA) was administered into the intrapleural space daily for three consecutive days. After the treatment, the loculations were resolved, fluid drainage was facilitated, and significant radiological and clinical improvement followed. In conclusion, tPA treatment provides favorable results in patients with parapneumonic pleural effusions that are unsuitable for surgery or unresponsive to standard therapy.

Keywords: Children, Empyema, Fibrinolysis, Parapneumonic Effusion, Pleural Effusion, Tissue Plasminogen Activator

Özet

İntraplevral fibrinolitik ajan uygulaması bazı hastalarda alternatif bir tedavi seçeneğidir. Ya hastanın genel durumu cerrahiye uygun değildir, ya da standart tedaviye rağmen (örneğin göğüs tüpü konulması, pleurodesis) iyileşme sağlanamamıştır. Ne yazık ki, fibrinolitik ajan uygulaması pratikte alternatif bir tedavi yaklaşımı olarak beklendiği kadar sunulmaz. Çalışmada, sağ alt lob pneumonisi sonrası oluşan parapneumonic pleural effusionu olan yedi yaşında erkek hasta sunulmuştur. Hasta, göğüs tüpü yerleştirilmesi ve geniş spektrumlu antibiyotik tedavisinden sonra minimal iyileşme gösterdi. Fakat intraplevral lokulasyon ve septasyonlar devam etti. Bunun üzerine arka arkaya üç gün boyunca günlük doku plazminojen aktivatörü (tPA) intraplevral olarak uygulandı. Tedavi sonrası lokülasyonlar azaldı, drenaj kolaylaştı, önemli radyolojik ve klinik iyileşme izlendi. Sonuç olarak cerrahi müdahaleye uygun olmayan veya standart tedaviye yanıt vermeyen parapneumonic pleural effusionu olan hastalarda tPA tedavisi başarılı sonuçlar vermektedir.

Anahtar Kelimeler: Çocuk, Ampiyem, Fibrinolizis, Parapnömonik Effüzyon, Plevral Effüzyon, Doku Plazminogen Aktivatörü

 


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Referanslar


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