chronic silicone embolism syndrome
- related: Pulmonology
- tags: #literature #boards
x200 and x400
The patient had a tear in one of her breast implants and had a large chronic leak of silicone that embolized hematogenously into her lungs, causing a pneumonitis. There is disruption of the lining of the implant, as seen on the chest CT scan. There are also bilateral infiltrates seen on her chest CT scan. The lung biopsy reveals the presence of multiple clear vacuoles containing translucent, refractile, nonbirefringent microdroplets within and adjacent to alveolar septal capillaries, surrounded by histiocytes and/or multinucleated giant cells. The morphology was consistent with silicone emboli (choice D is correct).
Silicone (polydimethylsiloxane) is an inert liquid polymer used in cosmetic procedures, including breast augmentation. Case reports have been described of silicone embolization, most cases from illegal injection of silicone subcutaneously into the buttocks for augmentation. This usually causes right heart failure and ARDS. Silicone microemboli derived from breast implants (even saline breast implants with silicone casings) can potentially embolize to the lung, causing a chronic form of lung disease mimicking interstitial lung disease.
Chronic silicone embolism syndrome is characterized by chronic dyspnea, onset of lung disease years after placement of breast implants, bilateral ground-glass opacities, and pathologic evidence of silicone microdroplets in and around alveolar septal capillaries associated with histiocytes and multinucleated giant cells.
The relationship between breast implants and lung disease may not be obvious, especially in patients with saline implants (with silicone capsules), with no obvious signs of implant rupture, and a long interval between placement of implants and development of respiratory symptoms.
There is no evidence of vasculitis on the pathology specimen (choice A is incorrect). There is no history of the use of mineral oils; she is at a young age to be at risk for aspiration, and the biopsy would show vacuoles with mineral oil in a more diffuse pattern (choice B is incorrect). There is no evidence of tumor seen in the pathology specimen (choice C is incorrect).1