Purpose: This study was done targeting the role of streptokinase injected through pigtail catheter in treatment of pleural empyema in pediatric. Subjects and methods: 15 patients were involved in this study of age ranged from 5 months to 15 years were subjected to STK injection once daily until the drainage don't exceed 100 ml/day and managed by ultrasound guided insertion of pigtail catheter. Broad spectrum antibiotics were given to all patients, after that the antibiotics were adapted

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... g to result of microbial culture because of failed chest tube drainage intrapleural STK is recommended. Results: 13 cases show significant improvement, as the total amount of fluid before streptokinase injection was 5 cc in average and significantly rose to 220 cc after streptokinase instillation, while 2 cases do not response to this treatment. Conclusion: Imaging guided streptokinase injected through a pigtail catheter provides a powerful protocol for managing of complicated empyema in pediatrics.