Eligibility

Inclusion Criteria:

• Referral to pulmonary services for inability to drain fully via IPC

• Presence of a symptomatic septated pleural effusion

• A pleural effusion of significant moderate to large volume based on:

  • Chest radiograph: effusion filling >= 1/3 of the hemithorax, or
  • Computed tomography (CT)-scan: AP depth of the effusion >= 1/3 of the AP dimension on the axial image superior to the hemidiaphragm, including atelectatic lung surrounded by effusion, or
  • Ultrasound: effusion spanning at least three intercostal spaces, with a >= 3 cm in at least one intercostal space, while the patient sits upright

• Age > 18

• Borg score >= 3

• Absence of a blocked IPC as demonstrated by a flush with 20 cc of saline x1 without resistance

• Draining < 150 cc and > 50 cc via IPC at follow up post IPC placement based on patient's drainage record

• Presence of septated effusion based on ultrasound (US) and chest CT

Exclusion Criteria:

• Inability to provide informed consent

• Study subject has any disease or condition that interferes with safe completion of the study including:

  • Uncorrectable Coagulopathy based on criteria followed by cardiopulmonary center for procedures. This will include patients on anticoagulation that can't be stopped
  • Active bleeding
  • Known allergic reaction to thrombolytics

• Pleural effusion is smaller than expected on bedside pre-procedure ultrasound

• No septations and/or no loculations on bedside pre-procedure ultrasound

• Patient is asymptomatic

• Blocked IPC as determined by saline flush

• Inability to undergo CT chest