The purpose of this prospective randomized clinical trial is to compare two currently
accepted standard-of-care treatment strategies: medical thoracoscopy as compared to
instillation of intrapleural tissue plasminogen activator (TPA) and human recombinant
deoxyribonuclease (DNase) for the management of complicated pleural infections in adults as
defined as complicated parapneumonic effusions or pleural empyema.