Management of traumatic hemothorax is an important problem in thoracic surgery. As an alternative to surgical treatment in patients who developed clotted hemothorax after trauma, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Aim of the study is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of post traumatic clotted hemothorax. Patients and Methods: our study included 40 patients presented with clotted hemothorax after chest trauma . Patients were divided into two groups each contains 20 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both were instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. Results: Alteplase give excellent results in clotted hemothorax , it showed dramatic improvement in both chest tube drain and pleural thickness without bleeding complications. Streptokinase protocol showed only improvement of chest tube drain. Conclusion : Intrapleural Alteplase is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with post traumatic clotted hemothorax.