The Safety and Efficacy of Fibrinolysis in Patients With an Indwelling Pleural Catheter for Multi-loculated Malignant Pleural Effusion.

Inclusion Criteria: * Malignant Pleural Effusion MPE (either cytology proven or recurrent exudative pleural effusion in the context of histologically proven cancer) * Presence of an indwelling pleural catheter (IPC) * Nondraining IPC (defined as \<50 mL of drainage on the past three drainage attempts) not responding to routine saline flush to assure patency * Residual pleural fluid remaining on chest x-ray (CXR) or ultrasound * Dyspnea deemed attributable to the effusion (i.e. symptomatic loculations), as assessed by the treating chest physician and using the modified Borg scale * Presence of written informed consent from the patient or surrogate Exclusion Criteria: * Age \<18 * Expected survival less than 14 days * Known allergy or intolerance to tissue plasminogen activator