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Background Intrapleural fibrinolytics are used in selected patients with indwelling pleural catheters (IPCs) and septated malignant pleural effusions (MPEs), but imaging data to support their effectiveness remain sparse.Aim To assess whether fibrinolytics administered via IPC lead to a change in objectively scored ultrasound-visible septations.Methods All patients from the Oxford Pleural Service who received intrapleural fibrinolytics via an indwelling pleural catheter (IPC) since routine ultrasound imaging has been recorded (2012–2025) were identified. Fourteen patients met inclusion criteria; 12 had stored thoracic ultrasound (TUS) images from before and after fibrinolysis. A standardised scoring system was developed to assess three domains: number of septations, septal thickness, and proportion of anechoic free fluid. All images were anonymised and presented in random order to an experienced pleural ultrasound practitioner, who was blinded to clinical information and whether the ultrasound was pre or post treatment.Results Initial analysis of the data demonstrates that fibrinolytic therapy was associated with a reduction in the number of pleural septations on ultrasound in most patients, and fluid drainage improved. Full assessment of the analysis will be presented at the BTS winter conference.Conclusion This study suggests that intrapleural fibrinolytics visibly reduce pleural septations on ultrasound in patients with IPCs and septated MPEs. These imaging findings offer support for a biological effect of fibrinolytics on pleural architecture and provide a rationale for further prospective studies. The ultrasound scoring approach used here could support objective imaging endpoints in future trials.References Rahman NM, Maskell NA, et al. N Engl J Med. 2011;365(6):518–26.Bedawi EO, et al. Am J Respir Crit Care Med. 2022;205(7):857–66.