Pulmonary Vascular Disease: Student/Resident Case Report Poster - Pulmonary Vascular Disease II |

Silicon Embolization Mimicking Bilateral Pneumonia FREE TO VIEW

Tawseef Dar, MD; Adil Mir, MD; Yub Raj Sedhai, MD; Tantary Mohmad, MD; James McMaster, DO
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Mercy Catholic Medical Center, Drexel Hill, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1221A. doi:10.1016/j.chest.2016.08.1330
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SESSION TITLE: Student/Resident Case Report Poster - Pulmonary Vascular Disease II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Silicone embolization following illicit use of Liquid injectable Silicon for soft tissue augmentation is a well-known phenomenon. Illicit use of Liquid injectable silicon for cosmetic augmentation of breasts & buttocks is quite common among certain professions especially strip dancers. In the United States, liquid silicone is FDA approved only for intraocular use.

CASE PRESENTATION: 25 year old female with history of bipolar disorder, anxiety disorder presented to our ED with c/o fever, SOB & generalized weakness of 1 week duration & in the ED was found to be tachycardic, febrile (100.5 F), tachypneic in moderate to severe respiratory distress. Chest examination revealed bibasilar rhonchi .Patient was saturating 93 % on 5 liters of O2 via NC. Patient ended up getting intubated. CXR showed bilateral lower lobe dense consolidation concerning for pneumonia. CT chest showed severe bilateral consolidative change, most prominent in the lower lobes. Patient was initially managed for pneumonia. But upon more detailed physical examination, she was found to have multiple tattoos & granulomatous patches in her buttocks. IV antibiotics were changed to IV steroids & patient responded dramatically with successful extubation.

DISCUSSION: The use of liquid injectable silicone for soft-tissue augmentation is controversial due to concern over the potential for long-term complications, which include respiratory compromise, infection & even death. Pulmonary manifestation can sometimes easily mimic bilateral pneumonia .Pulmonary manifestations of subcutaneous silicone injections are proposed to result from inadvertent injection of silicone directly into a vein & subsequent embolization into the lungs .The phenomenon is acute with symptoms presenting within 72 hours after injection in most cases. The pathologic findings on lung biopsy include alveolar hemorrhage, silicone deposits within the alveoli and inclusions within alveolar macrophages .The CT findings include peripheral, ground-glass opacities and low attenuation in affected lung .These findings can however be easily mistaken for bilateral pneumonia .Illicit use of silicone includes use by the strip dancers for their buttock augmentation, which was the case with our patient. Such patients can present with fever, cough associated with respiratory distress .One should have a very high degree of suspicion for silicone embolization syndrome to differentiate it from pneumonia .Steroids shave been showed to be effective in silicone embolization syndrome affecting lungs.

CONCLUSIONS: Silicon embolization syndrome affecting lungs should always be considered as a differential in patients having bilateral opacities. And our case also stresses the importance of history & physical examination, in raising your suspicion for silicon embolization syndrome.

Reference #1: Coulaud JM, Labrousse J, Carli P, Galliot M, Vilde F, Lissac J. Adult respiratory distress syndrome and silicone injection. Toxicol Eur Res. 1983 Jul;5(4):171-4.

DISCLOSURE: The following authors have nothing to disclose: Tawseef Dar, Adil Mir, Yub Raj Sedhai, Tantary Mohmad, James McMaster

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