Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas

Terry McNearney, Christopher Bajaj, Michael Boyars, John Cottingham, Abida Haque

Research output: Contribution to journalArticle

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1352-1354
Number of pages3
JournalDigestive Diseases and Sciences
Issue number7
StatePublished - Jul 1 2003



  • Alveolar granulomas
  • Crystalline precipitates
  • Parenteral nutrition
  • Pulmonary artery occlusion

ASJC Scopus subject areas

  • Gastroenterology

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