consistently , poor results have been reported by various authors due to presence of infected hematomas or presence of thick , viscous , and purulent material . several studies have proven the potential benefit of fibrinolytic therapy for treating abscesses , especially those with thick purulent material , old blood , or loculations . the present report of two cases highlights the efficacy of fibrinolytic therapy in loculated abscesses . to the best of author 's knowledge , this kind of therapeutic intervention in loculated abscess cavities has not yet been reported from india . a 14-year - old girl underwent excision of the posterior mediastinal tumor ( ganglioneuroma ) . three weeks later , she reported with high grade fever , vomiting , and backache . on admission , she was started on broad spectrum antibiotics and drainage of the abscess was established by 10 f pig tail catheter under ultrasonography guidance . after initial 50 ml drainage of thick , viscous and purulent material , there was no subsequent drainage , and she continued having fever . repeat ultrasonography revealed a residual collection with thick internal septations . injection urokinase ( uk ) 100,000 iu in 25 ml normal saline was instilled into abscess cavity 8 hourly . total 3 doses were given with a dwelling time of 2 h between each dose . chest radiograph showing mediastinal abscess chest radiograph showing pigtail catheter in abscess and resolution of abscess a 25-year - old male presented with complaints of cough with purulent expectoration , low grade fever and low backache of 1 month duration . chest radiograph and computed tomography scan revealed features of volume loss on left side with fibronodular opacities . radiograph of thoracolumbar spine , ultrasonography and magnetic resonance imaging ( mri ) [ figure 3 ] revealed bilateral psoas abscess . he was started on antitubercular treatment and pigtail catheters were placed under ultrasonography guidance in both abscess cavities . 150 ml and 60 ml of viscid , thick and purulent material was drained from right and left pigtail catheters respectively . repeat ultrasonography revealed no residual collection on right side and a significant collection with thick internal septations on left side . three doses of injection uk 50,000 iu each in 25 ml of normal saline were instilled 8 hourly with a dwelling time of 2 h between each dose through the left pigtail catheter . his repeat mri of thoracolumbar spine after 6 months revealed complete resolution of bilateral psoas abscesses [ figure 4 ] . a 14-year - old girl underwent excision of the posterior mediastinal tumor ( ganglioneuroma ) . three weeks later , she reported with high grade fever , vomiting , and backache . on admission , she was started on broad spectrum antibiotics and drainage of the abscess was established by 10 f pig tail catheter under ultrasonography guidance . after initial 50 ml drainage of thick , viscous and purulent material , there was no subsequent drainage , and she continued having fever . repeat ultrasonography revealed a residual collection with thick internal septations . injection urokinase ( uk ) 100,000 iu in 25 ml normal saline was instilled into abscess cavity 8 hourly . total 3 doses were given with a dwelling time of 2 h between each dose . chest radiograph showing mediastinal abscess chest radiograph showing pigtail catheter in abscess and resolution of abscess a 25-year - old male presented with complaints of cough with purulent expectoration , low grade fever and low backache of 1 month duration . chest radiograph and computed tomography scan revealed features of volume loss on left side with fibronodular opacities . radiograph of thoracolumbar spine , ultrasonography and magnetic resonance imaging ( mri ) [ figure 3 ] revealed bilateral psoas abscess . he was started on antitubercular treatment and pigtail catheters were placed under ultrasonography guidance in both abscess cavities . 150 ml and 60 ml of viscid , thick and purulent material was drained from right and left pigtail catheters respectively . repeat ultrasonography revealed no residual collection on right side and a significant collection with thick internal septations on left side . three doses of injection uk 50,000 iu each in 25 ml of normal saline were instilled 8 hourly with a dwelling time of 2 h between each dose through the left pigtail catheter . there was a net total drainage of 200 ml of thick purulent material . his repeat mri of thoracolumbar spine after 6 months revealed complete resolution of bilateral psoas abscesses [ figure 4 ] . fibrinolytics in loculated pleural collection due to pneumonia , empyema and tuberculosis have been in use for long time in abroad and for last few years in india . the rationale for the use of fibrinolytics for treating abscesses outside the pleural space is almost the same and was first suggested by haaga . since purulent material in loculated abscesses contains a high level of fibrin , fibrinolytics ( stk or the uk ) injected into purulent material retains its enzymatic properties and splits the fibrin thereby breaking the loculations . initially believed to be effective in reducing the viscosity of pus also , presently as per the recent evidence dnase and not fibrinolytics , decrease the viscosity of pus and the present status of fibrinolyticsis is mostly limited to breaking of loculations within the abscess cavity . our both cases had loculated abscesses as evidenced by insignificant drainage in spite of catheter being in situ and significant amount of fluid in abscess cavity as assessed by ultrasonography . reported dosing regimens for intracavitary fibrinolytic agents have been variable without any clear consensus or evidence favoring one protocol over another . haaga et al . based their protocol for abdominal abscesses on abscess size , with a dose of 12,500 iu for uk for cavities up to 3 cm in diameter , 25,000 iu for those of 3 - 5 cm in diameter , 50,000 iu for a 510 cm diameter , and 100,000 iu for those > 10 cm in diameter . the doses were administered every 8 h for 4 days with a clamp time of 15 min after each administration . we used dose of 100,000 iu and 50,000 iu of uk based on abscess size of 12 cm and 8 cm in case one and two respectively with a dwelling time of 2 h in 8 hourly dosages based on protocol used by haaga et al . absolute contraindications to fibrinolytic therapy include previous intracranial hemorrhage , ischemic stroke within 3 months and active bleeding or bleeding diathesis . the relative contraindications are systolic blood pressure more than 180 mmhg , major surgery within <3 weeks , pregnancy , current use of anticoagulants and active peptic ulcer . instillation of fibrinolytic agent in loculated abcess cavities facilitates drainage and is a safe , simple and cost effective adjunctive therapy .
the efficacy of fibrinolytic therapy in two loculated abscesses is being reported . 
 first case had a postoperative mediastinal abscess in left paraspinal location and the second case had two bilateral tubercular psoas abscesses . 
 both cases were managed with pig tail catheter drainage of abcesses and fibrinolytic therapy with instillation of urokinase followed by aspiration . 
 both cases had significant drainage , clinical and radiological resolution . 
 there were no adverse effects in either case .