TY - JOUR
T1 - Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas
AU - McNearney, Terry
AU - Bajaj, Christopher
AU - Boyars, Michael
AU - Cottingham, John
AU - Haque, Abida
PY - 2003/7/1
Y1 - 2003/7/1
N2 - This case report describes total parenteral nutrition (TPN) -associated crystalline precipitates occluding the pulmonary artery branches in a Crohn's disease patient who survived. These precipitates caused focal vascular disruptions and alveolar granulomas. High-resolution CT (HRCT) scan demonstrated a diffuse ground-glass appearance. Pulmonary function tests showed severe ventilatory defects, arterial hypoxemia, and decreased oxygen saturations. Energy dispersive x-ray analysis (EDAX) of the patient's lung biopsy and expectorant demonstrated similar patterns, supporting crystal migration into the alveoli. Treatment included broad-spectrum antibiotics, anticoagulation, corticosteroids, and daily pulmonary toilet. The patient required continuous supplemental oxygen for two months and then was able to use it intermittently. This patient survived widespread pulmonary vascular occlusions secondary to precipitation and crystallization of TPN solution, with moderately severe residual deficits in exercise tolerance and chest x-ray abnormalities. This case underscores the importance of surveillance and recognition and of TPN-associated complications by health care workers.
AB - This case report describes total parenteral nutrition (TPN) -associated crystalline precipitates occluding the pulmonary artery branches in a Crohn's disease patient who survived. These precipitates caused focal vascular disruptions and alveolar granulomas. High-resolution CT (HRCT) scan demonstrated a diffuse ground-glass appearance. Pulmonary function tests showed severe ventilatory defects, arterial hypoxemia, and decreased oxygen saturations. Energy dispersive x-ray analysis (EDAX) of the patient's lung biopsy and expectorant demonstrated similar patterns, supporting crystal migration into the alveoli. Treatment included broad-spectrum antibiotics, anticoagulation, corticosteroids, and daily pulmonary toilet. The patient required continuous supplemental oxygen for two months and then was able to use it intermittently. This patient survived widespread pulmonary vascular occlusions secondary to precipitation and crystallization of TPN solution, with moderately severe residual deficits in exercise tolerance and chest x-ray abnormalities. This case underscores the importance of surveillance and recognition and of TPN-associated complications by health care workers.
KW - Alveolar granulomas
KW - Crystalline precipitates
KW - Parenteral nutrition
KW - Pulmonary artery occlusion
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U2 - 10.1023/A:1024119512162
DO - 10.1023/A:1024119512162
M3 - Article
C2 - 12870794
AN - SCOPUS:0038388127
SN - 0163-2116
VL - 48
SP - 1352
EP - 1354
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 7
ER -