Other indications for drainage include poor clinical progress during treatment with antibiotics alone and patients with a loculated pleural collection.

Loculated pericardial effusions may not be apparent on standard posterior/anterior or lateral chest radiographic views.

Decubitus - useful for differentiating pleural effusions from consolidation (e.g. pneumonia) and Loculated effusions from free fluid in the pleura.

Approximately 15 to 40 percent of patients require surgical drainage of the infected pleural space because of inadequate drainage due to clogging of the chest tube or loculated empyema.

Hsu LH, Soong TC, Feng AC, et al.: Intrapleural urokinase for the treatment of loculated malignant pleural effusions and trapped lungs in medically inoperable cancer patients.

Lung reexpansion and resolution of dyspnea occurred in approximately 60% of patients, suggesting that intrapleural urokinase may be useful in treating loculated pleural effusions or trapped lungs in medically inoperable cancer patients.

A chest computerized tomography scan is more sensitive than a simple chest x-ray and is often used for assessment of loculated effusions because, in some instances, up to 500 cc of loculated fluid can be obscured behind the dome of the diaphragm.