The use of tPA ONLY has been reported in patients with a complicated pleural fluid collection, not due to infection (Heimes et al., PMID 28616283). The dose was 6 mg in 50 mL of normal saline instilled via a pleural chest tube. However, lower doses have been used (Thomas et al., PMID 25742001).

Loculated or un-loculated fluid collection, in pleural space must be evaluated to the best one can. Then, administer thrombolytics with or without alpha-dornase. Rotating patients may help. Usually, it should be able to spread diffusely in pleural space deloculation gently with Yonkers in pleural s...