Idiopathic pulmonary fibrosis associated with pulmonary vein thrombosis: a case report

BACKGROUND: Pulmonary vein thrombosis represents a potentially fatal disease. This syndrome may clinically mimic pulmonary embolism but has a different investigation strategy and prognosis. Pulmonary vein thrombosis is difficult to diagnose clinically and usually requires a combination of conventionally used diagnostic modalities. CASE PRESENTATION: The authors report a case of a 78-year-old previously healthy female presenting with collapse and shortness of breath. Serum biochemistry revealed acute kidney injury, positive D-dimmer's and increased C reactive protein. Chest radiography demonstrated volume loss in the right lung. The patient was started on antibiotics and also therapeutic doses of low molecular weight heparin. The working diagnosis included community acquired pneumonia & pulmonary embolism. A computed tomography pulmonary angiogram was performed to confirm the clinical suspicions of pulmonary embolism. This demonstrated a thrombus in the pulmonary vein, with associated fibrosis and volume loss of the right lower lobe. A subsequent thrombophilia screen revealed a positive lupus anticoagulant antibody and rheumatoid factor and also decreased anti thrombin III and protein C levels. The urine protein/creatinine ratio was found to be 553 mg/mmol. CONCLUSION: The diagnosis of this patient was therefore of idiopathic pulmonary fibrosis associated with pulmonary vein thrombosis. Whether or not the pulmonary vein thrombosis was a primary cause of the fibrosis or a consequence of it was unclear. There are few data on the management of pulmonary vein thrombosis, but anticoagulation, antibiotics, and, in cases of large pulmonary vein thrombosis, thrombectomy or pulmonary resection have been used

An experimental and analytical investigation of reinforced concrete beam-column joints strengthened with a range of CFRP schemes applied only to the beam

This paper investigates the experimental and analytical behaviour of beam-column joints that are subjected to a combination of torque, flexural and direct shear forces, where different Carbon Fibre Polymer (CFRP) strengthening wraps have been applied only to the beam. These wrapping schemes have previously been determined by the research community as an effective method of enhancing the torsional capacities of simply supported reinforced concrete beams. In this investigation, four 3/4-scale exterior beam-column joints were subjected to combined monotonic loading; three different beam wrapping schemes were employed to strengthen the beam region of the joint. The paper suggests a series of rational formulae, based on the space truss mechanism, which can be used to evaluate the joint shear demand of the beams wrapped in these various ways. Further, an iterative model, based on the average stress-strain method, has been introduced to predict joint strength. The proposed analytical approaches show good agreement with the experimental results. The experimental outcomes along with the adopted analytical methods reflect the consistent influence of the wrapping ratio, the interaction between the combined forces, the concrete strut capacity and the fibre orientation on the joint forces, the failure mode and the distortion levels. A large rise in the strut force resulting from shear stresses generated from this combination of forces is demonstrated and leads to a sudden-brittle failure. Likewise, increases in the beams’ main steel rebar strains are identified at the column face, again influenced by the load interactions and the wrapping systems used