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 supplementatio n. While receiving therapy he developed chest tightness, shortness of breat h, and fever. The chest radiograph showed bilateral reticulonodular opaciti es, 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 pulmon ary microvasculature. Microvascular emboli secondary to precipitated crysta ls is a potential complication of total parenteral nutrition. An awareness of the factors that influence crystal solubility may prevent adverse intera ctions in patients who require parenteral nutrition.