SESSION TITLE: Disorders of the Pleura Student/Resident Case Report Posters
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Pleural effusion is one of the rare complications associated with silicone breast implants. Herein, we present a middle aged female who developed significant pleural effusion six-weeks after silicone implants.
CASE PRESENTATION: A 44-year old female presented to the emergency department with the complaints of left sided pleuritic chest pain with worsening shortness of breath for three weeks duration without cough, sputum production, fever or chills. Her medical history was significant for Phyllodes tumor of the left breast, for which she underwent bilateral mastectomy and breast augmentation surgery with silicone implants six weeks ago. Lungs examination was consistent with left sided pleural effusion with normal examination of other systems. Chest radiograph and subsequent computed tomography (CT) of thorax confirmed a moderate to large left pleural effusion and atelectasis of the left lung. PET scan was normal. Labs revealed mild leucocytosis with ESR of 50 mm/hr and CRP of 17.9 mg/dl. Patient was treated with empiric antibiotics. Thoracentesis and placement of pigtail catheter yielded exudative fluid, which is negative for any bacteria, fungus and acid-fast bacilli. Fluid cytology revealed mesothelial cell, macrophages and lymphocytes with no malignant cells. The concern for foreign body reaction to implants or rupture or infected implants was raised with subsequent involvement of breast surgeon. In exploratory surgery, significant inflammation and mild fluid collection noted without any rupture. Patient’s symptoms significantly improved after the explantation.
DISCUSSION: Foreign body reaction (FBR) refers to inflammatory reaction provoked by implanted materials such as medical devices or breast implants . Tissue cells and infiltrated inflammatory cells create a dynamic microenvironment and produce different chemicals such as cytokines, chemokines and matrix metalloproteinases (MMPs) which in turn mediate FBR. In soft tissues, FBR presents as cellular inflammation and fibrous encapsulation with macrophages . Flessner et al.have demonstrated mesothelial cells, macrophages, fibroblasts, and T cells on the sterile catheters implanted into the rats’ abdomens for 20 weeks. Similarly, in the present case, cytology of pleural fluid revealed mesothelial cell, macrophages and lymphocytes with no malignant cells
CONCLUSIONS: Unexplained Pleural effusion in patients with breast implants should be evaluated as a possible rupture, infection or foreignbody reaction to silicone material and explantation is the choice in such patients.
Reference #1: Luttikhuizen DT, et al. Cellular and molecular dynamics in the foreign body reaction. Tissue Eng 2006;12(7):1955-70.
Reference #2: Donath K, et al. The histopathology of different foreign-body reactions in oral soft tissue and bone tissue. Virchow Archiv A 1992;420(2):131-7.
Reference #3: Stevens WMR, et al. Pleural effusion after rupture of silicone bag mammary prosthesis. Thorax 1987;42:825-6.
DISCLOSURE: The following authors have nothing to disclose: Imam Shaik, Bindu Gandrapu, Fernando Gonzalez, Amer Syed, Jyoti Matta
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