[What is your diagnosis? Secondary to chest trauma, the patient developed hemothorax].
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Fourteen of 15 patients (93%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase-streptodornase (SK-SD) injections. No significant adverse reactions occurred. One patient required decortication when SK-SD therapy failed. Intrapleural SK-SD is a safe, effective means of removing retained proteinaceous collections in the pleural space. It may obviate the need for more invasive procedures.
Some drugs are known to induce pleural effusion. Drug-induced pleural effusion is often associated with pleural fluid eosinophilia. Anticoagulant therapy may induce pleural effusion by at least two different mechanisms: bleeding complication (haemothorax) and allergic or toxic reaction. Authors describe 76-yr-old male with warfarin-induced pleural effusion. Since INR was 15.5, and the value of pleural effusion Hct exceeded significantly 50% of Hct value in blood, spontaneous haemothorax due to warfarin overdose was diagnosed. Pleural fluid analysis revealed relatively high percentage of eosinophils (13%), but it was probably secondary to the presence of numerous red blood cells in the effusion. The authors discuss different mechanisms of drug-induced pleural effusion, with special attention to eosinophilic pleural effusion and review the literature on the spontaneous haemothorax as a complication of anticoagulant therapy.
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Local fibrinolysis using streptokinase was used in two patients with an organizing extensive haemothorax. In both patients the coagula were dissolved and the pleural cavity was effectively evacuated by means of a drain without the necessity of an extensive surgical intervention. The authors did not record any side-reactions to the local administration of streptokinase. In the authors' opinion proper timing is important for achieving a satisfactory effect of local fibrinolysis. Fibrinolysis cannot be used in case of clinical signs of proceeding haemorrhage or closely after its termination.
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