Microvascular pulmonary emboli secondary to precipitated crystals in a patient receiving total parenteral nutrition: A case report and description of the high-resolution CT findings

A patient with a history of a small-bowel transplant that was subsequently resected required total parenteral nutrition for nutritional supplementation. While receiving therapy, he developed chest tightness, shortness of breath, and fever. The chest radiograph showed bilateral reticulonodular opacit...

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Bibliographic Details
Published inChest Vol. 115; no. 3; pp. 892 - 895
Main Authors REEDY, J. S, KUHLMAN, J. E, VOYTOVICH, M
Format Journal Article
LanguageEnglish
Published Northbrook, IL American College of Chest Physicians 01.03.1999
Subjects
Adult
Biological and medical sciences
Calcium Phosphates
Chemical Precipitation
Crystallization
Fatal Outcome
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Nervous system
Parenteral Nutrition, Total - adverse effects
Pulmonary Embolism - diagnostic imaging
Pulmonary Embolism - etiology
Radionuclide investigations
Solubility
Tomography, X-Ray Computed
Human
High resolution
Radiodiagnosis
Nutrition
Respiratory disease
Crystals
Cardiovascular disease
Thorax
Parenteral administration
Pulmonary capillary
Vascular disease
Pulmonary embolism
Case study
Calcium Phosphates
Precipitation
Medical imagery
Pulmonary vascular disease
Complication
Computerized axial tomography
Diagnosis
Resuscitation
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Summary:A patient with a history of a small-bowel transplant that was subsequently resected required total parenteral nutrition for nutritional supplementation. While receiving therapy, he developed chest tightness, shortness of breath, and fever. The chest radiograph showed bilateral reticulonodular opacities, and the high-resolution CT scan demonstrated diffuse, poorly marginated micronodular opacities in a miliary pattern. Pathology specimens obtained by transbronchial biopsy revealed amorphous material obstructing the pulmonary microvasculature. Microvascular emboli secondary to precipitated crystals is a potential complication of total parenteral nutrition. An awareness of the factors that influence crystal solubility may prevent adverse interactions in patients who require parenteral nutrition.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ObjectType-Report-1
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ISSN:0012-3692
1931-3543
DOI:10.1378/chest.115.3.892