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Silicone Embolism Syndrome
 Submitted by Joshua Clayton, MD

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

Silicone Embolism Syndrome. White arrows point to dense, peripherally located airspace disease which is documented on axial and coronal reformatted CT scans of the chest (blue arrows).
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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