Background: the management of loculated pleural effusion and empyema by chest tube drainage usually fails because of thick viscous fluid and multiple pleural space loculations. The use of radiographic assisted chest tube drainage with intrapleural fibrinolytic agents facilitates pleural drainage and can obviate the need for more invasive surgical interventions in these types of effusions. Objectives: to evaluate the role of radiographic chest tube drainage with intrapleural fibrinolytic therapy with streptokinase as an adjunctive therapy in the management of loculative pleural effusion and empyema Material and methods: 40 patients of CPE and empyema were considered for radiographic assisted chest tube drain with adjunctive intrapleural fibrinolytic therapy. Intrapleural, STK was administered 12-24 hourly in the dosage of 2, 50000 IU in 100 ml of saline. The end points were volume of fluid drained and radiological resolution and 40 patients were in the decortication group (control group0 Results: Statistical analysis showed a success of 65% in study group and in thoracotomy group 97.5% with minimal complications in both the groups. Conclusion: Patients of loculative pleural effusion/ empyema should be first subjected to radiographic assisted chest tube drainage as we have seen from results and then add fibrinolytic if loculations present.