Silicone Pneumonitis after a Cosmetic Augmentation Procedure
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《新英格兰医药杂志》
To the Editor: The injection of silicone for cosmetic procedures is common practice in the United States. We describe a case of severe silicone-induced pneumonitis leading to respiratory failure. A previously healthy 30-year-old woman presented with progressive cough and shortness of breath of 10 days' duration. For cosmetic augmentation, an unlicensed nurse had given the patient two silicone injections into her buttocks 12 days and 2 days before admission. At the initial evaluation, the patient's oxygen saturation was 63 percent while she was breathing ambient air; her pulse was 119 beats per minute, blood pressure 98/66 mm Hg, respiratory rate 20 breaths per minute, and temperature 38.3°C; auscultation revealed diffuse rhonchi throughout the lungs. Her chest radiograph showed infiltrates in the lower left lobe. Laboratory studies showed a white-cell count of 13,300 per cubic millimeter and a hematocrit of 37 percent. Arterial blood gas measurements revealed respiratory alkalosis with pronounced hypoxemia.
The patient was intubated electively for impending respiratory failure, and 100 ml of bright red blood, suggestive of alveolar hemorrhage, was aspirated from the endotracheal tube. The hematocrit dropped to 22 percent. A computed tomographic (CT) scan of her chest showed diffuse bilateral ground-glass opacities (Figure 1A). Open-lung biopsy showed lipoid vacuoles (Figure 1B and Figure 1C), consistent with silicone pneumonitis. Light and electron microscopy confirmed the presence of elemental silicon within the vacuoles. Methylprednisolone (250 mg intravenously every six hours) was administered for five days, then gradually tapered. The patient was extubated on day 7; her oxygen saturation remained at 98 to 100 percent, and the hematocrit rose to 41 percent.
Figure 1. CT Scan of the Chest and Lung-Biopsy Specimens.
A CT scan of the chest (Panel A) shows bilateral, diffusely distributed ground-glass opacities with superimposed dependent areas of consolidation. Biopsy specimens from the left lung (Panels B and C) show multiple lipoid vacuoles throughout the alveolar interstitium and focal thromboembolic occlusion of pulmonary-artery branches, consistent with silicone embolization.
Silicone-fluid induced embolism has been implicated by several studies as a cause of acute pneumonitis with alveolar hemorrhage in patients undergoing silicone injection for tissue augmentation.1,2,3 The patient described here presented with symptoms similar to those of the patients in a recent study, in which 92 percent of the patients with silicone embolism had hypoxemia, 88 percent dyspnea, 70 percent fever, and 64 percent alveolar hemorrhage.2 A CT scan of the patient showed diffuse air-space disease. These results were more radiologically advanced than previously reported,4 being proportional to the severity of the clinical and pathological findings in the patient. Silicone injections for cosmetic purposes should be considered a high-risk procedure.
Grigoriy E. Gurvits, M.D.
St. Vincent's Catholic Medical Center
New York, NY 10011
References
Chung KY, Kim SH, Kwon IH, et al. Clinicopathologic review of pulmonary silicone embolism with special emphasis on the resultant histologic diversity in the lung -- a review of five cases. Yonsei Med J 2002;43:152-159.
Smith A, Tzur A, Leshko L, Krieger BP. Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome. Chest 2005;127:2276-2281.
Chastre J, Brun P, Soler P, et al. Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men. Am Rev Respir Dis 1987;135:236-240.
Rosioreanu A, Brusca-Augello GT, Ahmed QA, Katz DS. CT visualization of silicone-related pneumonitis in a transsexual man. AJR Am J Roentgenol 2004;183:248-249.
The patient was intubated electively for impending respiratory failure, and 100 ml of bright red blood, suggestive of alveolar hemorrhage, was aspirated from the endotracheal tube. The hematocrit dropped to 22 percent. A computed tomographic (CT) scan of her chest showed diffuse bilateral ground-glass opacities (Figure 1A). Open-lung biopsy showed lipoid vacuoles (Figure 1B and Figure 1C), consistent with silicone pneumonitis. Light and electron microscopy confirmed the presence of elemental silicon within the vacuoles. Methylprednisolone (250 mg intravenously every six hours) was administered for five days, then gradually tapered. The patient was extubated on day 7; her oxygen saturation remained at 98 to 100 percent, and the hematocrit rose to 41 percent.
Figure 1. CT Scan of the Chest and Lung-Biopsy Specimens.
A CT scan of the chest (Panel A) shows bilateral, diffusely distributed ground-glass opacities with superimposed dependent areas of consolidation. Biopsy specimens from the left lung (Panels B and C) show multiple lipoid vacuoles throughout the alveolar interstitium and focal thromboembolic occlusion of pulmonary-artery branches, consistent with silicone embolization.
Silicone-fluid induced embolism has been implicated by several studies as a cause of acute pneumonitis with alveolar hemorrhage in patients undergoing silicone injection for tissue augmentation.1,2,3 The patient described here presented with symptoms similar to those of the patients in a recent study, in which 92 percent of the patients with silicone embolism had hypoxemia, 88 percent dyspnea, 70 percent fever, and 64 percent alveolar hemorrhage.2 A CT scan of the patient showed diffuse air-space disease. These results were more radiologically advanced than previously reported,4 being proportional to the severity of the clinical and pathological findings in the patient. Silicone injections for cosmetic purposes should be considered a high-risk procedure.
Grigoriy E. Gurvits, M.D.
St. Vincent's Catholic Medical Center
New York, NY 10011
References
Chung KY, Kim SH, Kwon IH, et al. Clinicopathologic review of pulmonary silicone embolism with special emphasis on the resultant histologic diversity in the lung -- a review of five cases. Yonsei Med J 2002;43:152-159.
Smith A, Tzur A, Leshko L, Krieger BP. Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome. Chest 2005;127:2276-2281.
Chastre J, Brun P, Soler P, et al. Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men. Am Rev Respir Dis 1987;135:236-240.
Rosioreanu A, Brusca-Augello GT, Ahmed QA, Katz DS. CT visualization of silicone-related pneumonitis in a transsexual man. AJR Am J Roentgenol 2004;183:248-249.