General Considerations
- Occurs following injection of liquid silicone, commonly for cosmetic purposes (most often young women and transgender females) due to low cost compared to plastic surgery
- Performed by unlicensed individuals at “pumping parties”
- Incidence unknown secondary to its illegal use by non-professionals
Pathophysiology
- Four types of histologic patterns have been seen
- Embolic
- Congestive
- Pneumonitis, and
- Diffuse alveolar damage
- Damage thought to be related to both mechanical obstruction of capillaries as well as activation of coagulation cascade following uptake by alveolar macrophages
- Silicone previously thought to be inert but recent evidence suggests silicone sensitivity in certain individuals following repeated exposure
Clinical Findings
- Similar to those of fat embolism, with vast majority of patients meeting the Criteria of Schonfeld for fat embolism syndrome
- Most commonly presents with predominantly respiratory symptoms
- Hypoxemia
- Dyspnea
- Fever
- Alveolar hemorrhage
- Neurologic involvement occurs in a smaller subset of individuals, uniformly fatal in documented cases
Imaging Findings
- Chest X-Ray
- Bilateral, diffuse alveolar opacities
- Parenchymal consolidation
- CT
- Ground glass opacities
- Peripheral distribution in over half of cases
- Less commonly, interlobular septal thickening or consolidation
Differential Diagnoses
- Acute alveolar disease
- Pulmonary edema
- Fat embolism
- Heart disease
- Adult respiratory distress syndrome (ARDS)
- Amniotic fluid embolism
- Neurogenic or High altitude pulmonary edema
- Diffuse alveolar hemorrhage
- Atypical pneumonia
- Pneumocystis (PJP, PCP)
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
- Respiratory syncytial virus bronchiolitis (RSV)
- Chronic interstitial disease
- Hypersensitivity pneumonitis (HP)
- Desquamative interstitial pneumonia (DIP)
- Nonspecific interstitial pneumonia (NSIP)
- Respiratory bronchiolitis interstitial lung disease (RBILD)
- Lymphocytic interstitial pneumonia (LIP)
- Sarcoidosis
- Pulmonary alveolar proteinosis (PAP)
- Drug toxicity
- Bronchiolitis obliterans with organizing pneumonia (BOOP, COP)
- Bronchoalveolar carcinoma
Treatment
- Supportive
- Supplemental oxygen
- Steroids
- Intubation if respiratory status indicates
Prognosis
- Overall mortality ~25%
- <10% with no neurologic involvement
- Approaching 100% with neurologic involvement
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Schmid, MD Tzur, MD, Leshko, MD Krieger, MD,FCCP; Silicone Embolism Syndrome
A Case Report, Review of the Literature, and Comparison With Fat Embolism Syndrome. CHEST June 2005 vol. 127 no. 6 2276-2281
Bartsich, Wu; Silicon emboli syndrome: A Sequela of clandestine liquid silicone injections. A case report and review of the literature. Journal of Plastic, Reconstructive & Aesthetic Surgery January 2010 Volume 63, Issue 1 Pages e1-e3
R. M. Goldblum MD, Corresponding Author Contact Information, A. A. O'Donell MD, Prof D. Pyron MTa, R. M. Goldblumb, R. P. Pelley MDc, A. A. O'Donelld and Prof J. P. Heggers PhD; Antibodies to silicone elastomers and reactions to ventriculoperitoneal shunts. The Lancet Volume 340, Issue 8818, 29 August 1992, Pages 510-513
Restrepo CS, Artunduaga M, Carrillo JA, et al. Silicone pulmonary embolism: report of 10 cases and review of the literature. J Comput Assist Tomogr. Mar-Apr 2009;33(2):233-7
Chung KY, Kim SH, Choi YS, et al. Clinicopathologic review of pulmonary silicone embolism with special emphasis on the resultant histologic diversity in the lung e a review of five cases.Yonsei Med J 2002;43:152e9.
Shah, Rosita and Wallace Miller, Jr. Isolated Diffuse Ground-Glass Opacity in Thoracic CT: Causes and Clinical Presentations. AJR 2005; 184:613-622
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