Investig Magn Reson Imaging.  2015 Sep;19(3):191-195. 10.13104/imri.2015.19.3.191.

Chest Wall Lipogranuloma after Hydrogel Implant Rupture: Case Report

• Park SY
• Han BK
• Cho EY
• Bang SI

• KMID: 2175615
• DOI: http://doi.org/10.13104/imri.2015.19.3.191

Abstract

We present a 53-year-old woman with a large chest wall mass in the interpectoral space, which was eventually confirmed as a lipogranuloma resulting from hydrogel implant rupture. Ultrasonography (US) showed reduced implant volume with surrounding peri-implant fluid collection, suggesting the possibility of implant rupture. A heterogeneously hypoechoic mass was found between the pectoralis major and minor muscles adjacent to the ruptured implant. On magnetic resonance imaging (MRI), there was a large mass in the left interpectoral space of the upper inner chest wall. The mass showed slightly high signal intensity (SI) on pre-contrast T1-weighted image (WI) with mixed iso and high SI on T2-WI. The signal of the mass was suppressed using the water suppression technique but not with the fat suppression technique on T2-WI. The mass showed diffuse enhancement upon contrast enhancement. The enhancing kinetics showed persistent enhancement pattern. US-guided core needle biopsy revealed a lipogranuloma and removal confirmed a ruptured PIP hydrogel implant.

Keyword

Lipogranuloma; Chest wall; Hydrogel implant; Breast

MeSH Terms

Biopsy, Large-Core Needle
Breast
Female
Humans
Hydrogel*
Kinetics
Magnetic Resonance Imaging
Middle Aged
Muscles
Rupture*
Thoracic Wall*
Thorax*
Ultrasonography
Water
Hydrogel
Water

Figure

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  Fig. 1 Transverse ultrasonography of left upper chest wall (a) and breast area (b). (a) Ultrasonography shows a 5-cm-sized, ill-defined heterogeneously echogenic mass (arrows) between pectoralis major (PM) and minor (Pm) muscle, superior to the implant. (b) The implant shows a reduced volume with peri-implant fluid collection (dotted arrows).

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  Fig. 2 Axial MRI of the breast. On MRI at the mass level, an 8 × 8 × 2 cm mass in the left interpectoral space of upper inner chest wall (arrows) shows slightly high signal intensity (SI) compared to the muscle in pre-contrast T1-weighted image (WI) and it shows a mixture of iso and high SI on T2-WI. The signal of the mass is suppressed by water suppressed T2-WI but not by fat suppressed T2-WI. The mass shows diffuse enhancement by contrast enhanced (CE) T1-WI.

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  Fig. 3 On MRI at the implant level, the left subpectoral implant is collapsed with a linguine sign, representing a rupture (arrows). The SI of the implant is low on T1-WI and high in T2-WI and is suppressed by water suppressed T2-WI but not by fat suppressed T2-WI, which is compatible with hydrogel implants and not with silicone implants.

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  Fig. 4 (Upper) The core biopsy specimen consists almost entirely of homogenous lipid-containing macrophages without extracellular fat vacuoles (Hematoxylin & Eosin, × 400). (Lower) Intracellular fat components show positive Sudan black B staining (arrows) (Sudan black B, × 400).

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