Tuberc Respir Dis.  2004 Nov;57(5):465-469.

Major Hemothorax Induced Hypovolemic Shock Fallowing Administration of Intrapleural Urokinase

• Kim JK
• Jung IB
• Son JW
• Choi E
• Na MJ
• Lee WY
• Cho YJ

Abstract

Exudative pleural effusion can arise from pneumonia, tuberculosis, cancer, etc. Early drainage is needed for prevention of complications such as pleural fibrosis, thickening, bronchopleural fistulae and decline of lung function. Intrapleural Instillation of fibrinolytic enzymes has been used for 50years as an adjunct in the removal of fibrous material, hematoma and pus from the thoracic cavity. By the local fibrinolytic effect on fibrinous exudates within the pleural space, fibrinolytic agent has improved results of chest tube or pig tail drainage. But there were no controlled randomized studies, so significant controversy exists concerning the efficacy of this therpy, especially tuberculous pleurisy. Furthermore about complication, severe spontaneous bleeding has not been reported with intrapleural urokinase. Intrapleural fibrinolytic enzymes has shows no systemic complication. When it is administrated intravenously, not into intrpleural space, major bleeding is reported about 1-3% of patient, especially they had systemic disease, such as coagulation abnormalities. This case report presents a patient who suffered major hemothorax induced hypovolemic shock following the administration of 100,000 units of urokinase intrapleurally. He was 25-year old male with tuberculosis pleurisy without systemic illness demonstraion.

Keyword

Urokinase; Hemothorax; Hypovolemic shock; Pleural effusion

MeSH Terms

Adult
Chest Tubes
Drainage
Exudates and Transudates
Fibrin
Fibrosis
Fistula
Hematoma
Hemorrhage
Hemothorax*
Humans
Hypovolemia*
Lung
Male
Pleural Effusion
Pleurisy
Pneumonia
Shock*
Suppuration
Thoracic Cavity
Tuberculosis
Tuberculosis, Pleural
Urokinase-Type Plasminogen Activator*
Fibrin
Urokinase-Type Plasminogen Activator