Four case of silicone fluid induced acute pulmonary embolism

Seo, Young Bae; Chung, Jae Hyug; Park, Sang Min; Choi, Jong Hyun; Kim, Kyung Cheon; Choi, Ki Young; Shin, Hyun Soo

Abstract

Silicone(polydimethylsiloxane) is a liquid polymer, widely used for medical purpose, especially breast augmentation and other cosmetic procedures, with a minimal tissue reaction and a high degree of thermal stability. Illegal injections of slilicone in human beings, however have been associated with many adverse effects, including migration of the silicone, skin hypopigmentation, granulomatous hepatitis, mastitis, human adjuvant disease (progressive systemic sclerosis, SLE, mixed connective tissue disease, rheumatoid Arthritis, Hashimoto's thyroiditis, morphea, etc.). Pulmonary involvement has rarely been mentioned in the literature. We experienced the unusual four cases of respirtory difficulty after injection of liquid silicone in the breast, vigina, uterus, hip. They were all young adult female and previously healthy, one of them died of the injection, and the others survived with health. Two patients were admitted because of dypena, cough, chest discomfort and bilateral pulmonary infiltration after injection of silicone. Transbrochial lung biopsy and autopsy disclosed numerous oil like materials filling the alveolar septal capillaries and marcrophages. High resolution C.T. disclosed multiple alveolar lesion in the peripheral lesion of both lung. Transbronchial lung biopsy, autopsy, high resolution C.T. lung scan disclosed abnormalities compatible with silicone fluid induced pulmonary embolism, which is followed by acute respiratory distress syndrome, especially after injection of liquid silicone in the vagina, uterus. The other patients had mild dypnea, cough, pulmonary function test initially showed mild restrictive pattern in one patient. Lung scan disclosed abnormalities compatible with silicone induced pulmonary embolism, after injection in the hip, breast. It is strongly suggested that illegal injection of slilicone fluid carries pulmonary problem and can induce acute pulmonary embolism followed by acute respiratory distress syndrome, especially after silicone injection in vigina and uterus surrounded by numerous blood vessels.