Pulmonary embolism and septic emboli
Pulmonary embolism (a blood clot in the lung) causes pulmonary infarction (the death of lung tissue) less than 15% of the time, and only about 5% of pulmonary infarctions result in lung cavities. Septic pulmonary emboli (infected blood clots) are collections of infectious organisms, fibrin, and platelets that travel through the blood to the lung and cause small areas of pulmonary infarction by blocking off blood flow. This results in multiple small cavities 85% of the time. Symptoms can include cough, dyspnea (shortness of breath), chest pain, hemoptysis (coughing up blood) and sinus tachycardia (a fast heart rate). Risk factors for septic pulmonary emboli include IV drug use, implanted prosthetic devices (like central lines, pacemakers, and right-sided heart valves), and septic thrombophlebitis (a blood clot in a vein due to infection). Two forms of septic thrombophlebitis include pelvic thrombophlebitis and Lemierres syndrome (septic thrombophlebitis of the internal jugular vein). Trauma
Pulmonary contusion (lung bruise) from blunt chest trauma causes bleeding into the alveoli (air sacs) and can cause small cavities to form that are called traumatic pulmonary pseudocysts (TPP). This is rare, as less than 3% of lung injuries lead to TPP. It can occur at any age, but is more common in children and adults under the age of 30. Although it can occur anywhere in the lung, it is most common in the lower lobes. TPP usually resolves on its own within four weeks.
There is little evidence that most of the commonly used treatments for hyphema (antifibrinolytic agents [oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid], corticosteroids [systemic and topical], cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest) are effective at improving visual acuity after two weeks. Surgery may be necessary for non-resolving hyphemas, or hyphemas that are associated with high pressure that does not respond to medication. Surgery can be effective for cleaning out the anterior chamber and preventing corneal blood staining.If pain management is necessary, acetaminophen can be used. Aspirin and ibuprofen should be avoided, because they interfere with platelets ability to form a clot and consequently increase the risk of additional bleeding. Sedation is not usually necessary for patients with hyphema. Aminocaproic or tranexamic acids are often prescribed for hyphema on the basis that they reduce the risk of rebleeding by inhibiting the conversion of plasminogen to plasmin, and thereby keeping clots stable. However, the evidence for their effectiveness is limited and aminocaproic acid may actually cause hyphemas to take longer to clear. Prognosis
Hyphemas require urgent assessment by an optometrist or ophthalmologist as they may result in permanent visual impairment.A long-standing hyphema may result in hemosiderosis and heterochromia. Blood accumulation may also cause an elevation of the intraocular pressure. On average, the increased pressure in the eye remains for six days before dropping. Most uncomplicated hyphemas resolve within 5–6 days.