Intracavitary fibrinolysis directly under vision during medical thoracoscopy: a case report

Medical thoracoscopy is a minimally invasive single-port endoscopic technique that allows for direct visualization of the pleural surface as well as diagnostic and therapeutic procedures. When fibrous adhesions are extensive, its utility is limited. In patients with malignant pleural effusion and loculated effusion, fibrinolytics have been used through chest drainage to break down septations to relieve breathlessness and to improve pleurodesis success We described the use of intrapleural fibrinolytics during a medical thoracoscopy to break the septations and perform pleural biopsies in a patient with multiloculated pleural effusion. To the best of our knowledge, no studies on this subject have been published in the literature, only case reports. We believe that direct instillation of fibrinolytics during medical thoracoscopy is safe and has the potential to increase both the therapeutic and diagnostic capacity of medical thoracoscopy and fibrinolysis.