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 ad- vances, including video-assisted thoracoscopic surgery and intrapleural fibrinolytic therapy, offer new options for effective treatment. We report the first case of suc- cessful 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. Pediatrics 2003;111:e188 -e190. URL: http://www. pediatrics.org/cgi/content/full/111/2/e188; parapneumonic effusion; intrapleural fibrinolytic therapy; tissue plasmin- ogen activator; alteplase.