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Shaheen S, Al-Habbaa A, Riad MS, Mandour AS, Elzeny MA, Alnady K. Fatal pulmonary embolism following injectable gluteal filler usage: a case report. Egypt Heart J 2023; 75:83. [PMID: 37816906 PMCID: PMC10564681 DOI: 10.1186/s43044-023-00415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Despite the fact that injectable filler usage in the gluteal region has not been recommended in formal medical institutions, illegal procedures are performed in many clinics and beauty centers across Egypt. This case report illustrates the illegal practice culminating in a fatal complication. CASE PRESENTATION A 26-year-old female with no relevant medical history presented to the ER with acute onset shortness of breath. The complaint started 16 h before, with a rapidly progressive course, shortly after undergoing a gluteal filler injection at a center in Cairo. At ER, the patient was severely distressed, yet fully conscious and oriented. She was shocked (BP 70/40 mmHg), tachycardic (130 BPM), and tachypneic (30/min) with normal temperature. She had congested pulsating neck veins with positive Kussmaul sign. Chest auscultation revealed normal vesicular breathing with equal air entry and no adventitious sounds. Her O2 saturation was 60% on room air that improved to 85% on O2 mask. ECG showed sinus tachycardia. Echocardiography showed dilated right side, D-shaped septum with systolic flattening, dilated IVC, mild tricuspid regurgitation and estimated RV systolic pressure 53 mmHg. Her ABG showed compensated metabolic acidosis with elevated lactate level. At the ICU, CVP was 18 mmHg. Saline infusion was continued along with noradrenaline infusion initiation. A provisional diagnosis of high-risk pulmonary embolism was made, though CT pulmonary angiography was not available. Accordingly, thrombolytic therapy was initiated with alteplase (100 mg) over 2 h. Also, a dose of pulse steroids (methylprednisolone 200 mg) was given. Chest X-ray showed bilateral heterogenous opacity and ABG showed deteriorating hypoxia and combined metabolic and respiratory acidosis. The patient was intubated upon deterioration of conscious level and was put on mechanical ventilation. Her ET tube showed frequent blood-tinged secretions. Echocardiography showed more right-side dilatation that was consistent with deterioration of clinical status. Three hours after admission the patient developed cardiac arrest and died 2 h later. CONCLUSIONS This case report highlights the dangers associated with injectable filler usage in the gluteal region. Physicians and patients should be aware of the possible complications and how to avoid it.
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Affiliation(s)
- Sameh Shaheen
- Ain-Shams University, Faculty of medicine, Cairo, Egypt.
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt.
| | - Ahmed Al-Habbaa
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Al-Azhar University, Faculty of medicine, Cairo, Egypt
| | - Mohamed Saeid Riad
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Kobri El-Kobba Military Hospital, Cairo, Egypt
| | | | | | - Khaled Alnady
- Armed Forces College of Medicine (AFCM), Cardiology department, Cairo, Egypt
- Military Medical Academy, Cairo, Egypt
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2
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Elahi L, Ulrich F, Raffoul W, Rossi SA. Management of a Large Quantity of Permanent Gluteal Copolyamide Fillers (Aqualift/Activegel): Literature Review and Algorithm. Aesthet Surg J Open Forum 2022; 4:ojac051. [PMID: 35979376 PMCID: PMC9376670 DOI: 10.1093/asjof/ojac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Buttock augmentation is a commonly performed aesthetic surgery. Several methods have been described, but only the use of implants or autologous fat is consensually deemed safe and effective. Synthetic fillers in gluteal augmentation have been described despite potential severe long-term complications, both medical and aesthetic. The aim of this study is to report a series of 2 consecutive cases who underwent buttock and hip augmentation with large volumes of permanent copolyamide filler requiring surgical removal due to significant complications. Based on these cases and a review of recent literature, a management algorithm is proposed. The authors conducted a retrospective chart review of 2 consecutive cases of failed copolyamide filler augmentations in the gluteal and inguinal regions. The authors conducted a literature overview using PubMed (National Institutes of Health, Bethesda, MD) and Google Scholar (Google, Mountain View, CA) to include all articles concerning the removal of large quantities of permanent copolyamide fillers. Based on the physical properties of copolyamide, resection of the filler was performed by percutaneous aspiration with liposuction cannulas, with varying infiltration protocols. Both cases showed successful removal of major parts of the filler; however, residual material tended toward migration, requiring a secondary intervention. Hydrated low-pressure aspiration can manage nonintegrated gluteal copolyamide filler but will achieve only partial resection. Literature shows that radical excision is possible, however, with major drawbacks in function and aesthetics. Moreover, in acute inflammation and infection, an open approach should be preferred. Level of Evidence 5
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Affiliation(s)
- Leslie Elahi
- Corresponding Author: Dr Leslie Elahi, Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. E-mail:
| | - Franzisca Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Severin Alexander Rossi
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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3
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Madan N, Khan U, Martins A, Andries G, Matthews J, Patel V, Visveswaran G. Recurrent Silicone Embolism Syndrome requiring VA ECMO. Respir Med Case Rep 2022; 36:101576. [PMID: 35111570 PMCID: PMC8790489 DOI: 10.1016/j.rmcr.2021.101576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
The illegal use of liquid silicone in injectable procedures has been on the rise for the last few years. While originally thought to be an inert material, today, silicone is associated with several inflammatory complications-including Silicone Embolism Syndrome (SES). SES is the most dreaded complication of unlicensed liquid silicone injections. It is characterized by pneumonitis, diffuse alveolar and silicone pulmonary emboli leading to acute respiratory distress syndrome and cardiopulmonary failure. We present a case of a patient who was diagnosed with SES after she received unlicensed liquid silicone injections for gluteal augmentation. Her disease necessitated treatment with veno-arterial extracorporeal membrane oxygenation. Her neurological status remained poor. Our patient was also treated for SES status-post illicit silicone injections several years prior to the current episode. To our knowledge, this is the only reported instance of the same patient experiencing SES status-post illicit silicone injections on two separate occasions. Our patient's case suggests that robust education is needed for patients and the general public regarding the dangers of illicit body modifications. Given the widespread availability of counterfeit “medical grade” silicone, it is likely that the number of SES cases will continue to increase. Physicians must to be able to recognize the symptoms of SES, and not discount the possibility that patients will continue to receive illicit injections-even if they experienced devastating consequences the first time.
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Affiliation(s)
- Nikhil Madan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, 07112, USA
- Corresponding author. Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA.
| | - Umair Khan
- Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, 07112, USA
| | - Anthony Martins
- St George Univeristy Medical School, Great River NY, 11739, USA
| | - Gabriela Andries
- Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, 07112, USA
| | - John Matthews
- Department of Neuroradiology, Newark Beth Israel Medical Center, Newark, NJ, 07112, USA
| | - Vipul Patel
- Division of Lung Transplant, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Gautam Visveswaran
- Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, 07112, USA
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4
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Melo GB, Shoenfeld Y, Rodrigues EB. The risks behind the widespread use of siliconized syringes in the healthcare practice. Int J Retina Vitreous 2021; 7:66. [PMID: 34717776 PMCID: PMC8557543 DOI: 10.1186/s40942-021-00338-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/16/2021] [Indexed: 11/10/2022] Open
Abstract
Injections are widely performed in the healthcare practice. Silicone has long been thought to be an inert and harmless material. Although used for decades in medical implants, including heart valves, breast implants, and as a tamponade for retinal detachment surgery, silicone oil might have deleterious effects. Agitation of the syringe to expel air at the moment of drug preparation not only leads to silicone oil release but also to therapeutic protein aggregation. Lab studies have shown that silicone oil microdroplets can act as an adjuvant to promote a break in immunological tolerance and induce antibody response. Similarly, recent studies have suggested a causal link between agitation of siliconized syringes and ocular inflammation after intravitreal injection. Systemically, silicone oil has been reported in association with autoimmune diseases and skin granuloma after either direct injection of dermal fillers or secondary leakage from silicone breast implant. However, it has not been established yet a potential link between the silicone oil released by the syringes and such relevant systemic adverse events. Few professionals are aware that agitation of a siliconized syringe might lead to silicone oil release, which, in turn, acts an adjuvant to an increased immunogenicity. We strongly recommend that every healthcare professional be aware of the use of silicone oil in the syringe manufacturing process, the factors that promote its release and the potential complications to the organism. Ultimately, we recommend that safer syringes be widely available.
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Affiliation(s)
- Gustavo Barreto Melo
- Department of Ophthalmology, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil. .,Hospital de Olhos de Sergipe, Rua Campo Do Brito, 995, Aracaju, Brazil.
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University School of Medicine, Tel-Aviv, Israel
| | - Eduardo Büchele Rodrigues
- Department of Ophthalmology, SSM Health Saint Louis University Hospital, Saint Louis University, Saint Louis, USA
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5
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Characteristics and treatment of silicone granulomas: A retrospective multicenter cohort of 21 patients. JAAD Int 2021; 3:111-114. [PMID: 34409379 PMCID: PMC8362293 DOI: 10.1016/j.jdin.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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6
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Sergi FD, Wilson EC. Filler Use Among Trans Women: Correlates of Feminizing Subcutaneous Injections and Their Health Consequences. Transgend Health 2021; 6:82-90. [PMID: 33937525 DOI: 10.1089/trgh.2020.0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Purpose: Subcutaneous injections, or "fillers," are used illicitly and in large quantities by trans women for feminization. They are associated with severe complications, but data on their use are limited, especially in places with widespread access to safe gender-affirming care. Our analysis seeks to assess the prevalence, correlates, and complications of filler use to inform prevention and treatment. Methods: A secondary analysis of cross-sectional survey data from the Trans* National Study conducted from May 2016 to December 2017 of 631 adult trans women in the San Francisco Bay Area, California, recruited using respondent-driven sampling. Results: Around 65/631 participants (10.3%) reported filler use. Filler use was highest among Latinas (21.3% vs. 3.8% among whites, p<0.001), high school graduates (22.6% vs. 1.7% among college graduates, p<0.001), and those with a history of being undocumented (31.7% vs. 16.3% among documented immigrants and 6.4% among U.S. natives, p<0.001). Filler users had higher odds of engaging in sex work ever (odds ratio [OR] 3.3, p<0.001) and in the last 6 months (OR 2.00, p=0.049). The majority of filler users (78.5%) reported a physical complication, including infectious and inflammatory responses, coagulopathies, and neuropathies. Conclusion: Filler use was high among participants, despite availability of gender-affirming care and prevalence of complications. Filler use was highest among those with social, economic, and political vulnerabilities. Thus, filler use might be associated with structural factors that reduce access to safer methods of feminization. Addressing these factors, increasing access to safe gender-affirming care, and developing protocols for filler-related complications are needed.
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Affiliation(s)
- Francesco D Sergi
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
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7
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Bonfirraro PP, Sallam D, Verga M, Righi B, Mevio G, Codazzi D, Leone F, Carminati M. A Rare Case of Pulmonary Restrictive Syndrome after Liquid Silicone Injection: The Role of the Plastic Surgeon. Indian J Plast Surg 2021; 54:90-93. [PMID: 33814749 PMCID: PMC8012792 DOI: 10.1055/s-0040-1721862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite being especially used in its solid form, silicone is still injected as a liquid filler for breast contouring in many countries. Here, we present a rare case of a woman with silicone pneumonitis and extended breast scarring after breast silicone injection. Because of evidence of a restrictive syndrome due to the thoracic extensive scarring tissue and the high demand of oxygen therapy, as jointly agreed with the pulmonologists, we decided to perform a surgical asportation of the scarring tissue and covering with microsurgical flap. We chose the deep inferior epigastric perforator flap mainly because of the large amount of skin that is possible to use, the good skin texture matching, and the possibility of double team working without changing patient’s position.
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Affiliation(s)
- Pier Paolo Bonfirraro
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Sallam
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Verga
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bernardo Righi
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gabriele Mevio
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Denis Codazzi
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Leone
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marcello Carminati
- Department of Plastic and Reconstructive Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
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8
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Singarajah A, Wang A, Sayegh J, Vilke GM, Quenzer FC. "Botched": A Case Report of Silicone Embolism Syndrome After Penile and Scrotal Injection. Clin Pract Cases Emerg Med 2020; 4:595-598. [PMID: 33217281 PMCID: PMC7676808 DOI: 10.5811/cpcem.2020.9.48838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Silicone has been commonly used for both major and minor plastic and reconstructive surgery for decades. Due to the high costs associated with minor cosmetic procedures and plastic surgery, the unauthorized use of silicone injections by laypersons has become increasingly common. Improper or illegal subcutaneous injectable silicone has caused significant pulmonary complications and neurological complications, which can range from mild chest pain, hypoxia, and respiratory failure to coma and altered mental status. CASE REPORT We present a patient who had a rare complication of respiratory failure secondary to silicone embolism syndrome (SES). SES is a rare, potentially deadly complication and has been associated with subcutaneous silicone injections. The diagnosis of SES can be challenging and requires a thorough patient history indicating recent cosmetic procedures. CONCLUSION This case describes the first case of SES of a male patient who presented to a community emergency department complaining of dyspnea after an episode of self-administered injectable silicone into his penis and scrotum and who developed SES-induced respiratory failure.
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Affiliation(s)
- Anantha Singarajah
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, Tennessee
| | - Albert Wang
- Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California
| | - Julie Sayegh
- Los Alamitos Medical Center, Department of Emergency Medicine, Los Alamitos, California
| | - Gary M Vilke
- University of California, San Diego, Department of Emergency Medicine, San Diego, California
| | - Faith C Quenzer
- University of California, San Diego, Department of Emergency Medicine, San Diego, California
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9
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Ng BH, Mat WRW, Abeed NNN, Hamid MFA, Yu‐Lin AB, Soo CI. Silicone pneumonitis after gluteal filler: a case report and literature review. Respirol Case Rep 2020; 8:e00538. [PMID: 32076554 PMCID: PMC7028525 DOI: 10.1002/rcr2.538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Liquid silicone (polydimethylsiloxane) is an inert material that is commonly used for cosmetic purpose. Silicone embolization syndrome (SES) can rapidly progress to pneumonitis as a consequence of the injection of nonmedical-grade liquid silicone. We describe a case of severe silicone pneumonitis complicated with acute respiratory distress syndrome and bilateral pneumothorax secondary to silicone gluteal augmentation. In this case report, we aim to discuss our experience and approach in managing an uncommon case of SES.
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Affiliation(s)
- Boon Hau Ng
- Pulmonology Unit, Department of Internal Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Wan Rahiza Wan Mat
- Department of Anesthesiology and Intensive Care Unit, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Nik Nuratiqah Nik Abeed
- Pulmonology Unit, Department of Internal Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Mohamed Faisal Abdul Hamid
- Pulmonology Unit, Department of Internal Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Andrea Ban Yu‐Lin
- Pulmonology Unit, Department of Internal Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Chun Ian Soo
- Pulmonology Unit, Department of Internal Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
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10
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Ten-Year and Beyond Follow-up After Treatment With Highly Purified Liquid-Injectable Silicone for HIV-Associated Facial Lipoatrophy: A Report of 164 Patients. Dermatol Surg 2019; 45:941-948. [PMID: 30893157 DOI: 10.1097/dss.0000000000001889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Highly purified liquid-injectable silicone (LIS) has been established as a permanent agent for off-label correction of HIV-associated facial lipoatrophy (HIV-FLA). However, controversy exists about long-term safety. OBJECTIVE To establish the safety and efficacy at 10 years or greater of LIS for HIV-FLA. METHODS Patients from 3 practices with 10-year or greater in-person office follow-up were analyzed to determine the number of LIS treatments and total volume required to achieve optimal correction. The nature of any treated adverse events was noted. RESULTS One hundred sixty-four patients had 10-year or greater in-office follow-up. All subjects maintained long-term correction with an average of 9 treatments, average of 1.56 mL per treatment, and an average total of 14.1 mL. Two patients had severe adverse events manifesting as temporary facial edema. Four patients experienced mild-to-moderate excess fibroplasia presenting as perceived overcorrection, and 6 patients had nondisfiguring subcutaneous firmness. All adverse events were successfully treatable, mostly with intralesional 5-fluorouracil and triamcinolone. CONCLUSION Liquid-injectable silicone is an effective long-term treatment option for HIV-FLA. When injected in small quantities with the microdroplet serial puncture technique at monthly or greater intervals, optimal correction appears durable for more than 10 years. Adverse events consisted mostly of excess fibroplasia and were treatable.
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11
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Milroy CM, Parai JL. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Acad Forensic Pathol 2019; 9:136-154. [PMID: 32110249 PMCID: PMC6997986 DOI: 10.1177/1925362119896351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
Fat embolism is common following trauma and is a common autopsy finding in these cases. It may also be seen in non-traumatic cases and is seen in children as well as adults. In comparison fat embolism syndrome (FES) only occurs in a small number of trauma and non-trauma cases. Clinical diagnosis is based on characteristic clinical and laboratory findings. Fat embolism exerts its effect by mechanical blockage of vessels and/or by biochemical means including breakdown of fat to free fatty acids causing an inflammatory response. Fat embolism can be identified at autopsy on microscopy of the lungs using fat stains conducted on frozen tissue, including on formalin fixed but not processed tissue. With FES fat emboli can be seen in other organs including the brain, kidney and myocardium. Fat can also be identified with post-fixation staining, typically with osmium tetroxide. Scoring systems have been developed to try and determine the severity of fat embolism in lung tissue. Fat embolism is also common following resuscitation. When no resuscitation has taken place, the presence of fat on lung histology has been used as proof of vitality. Diagnosis of fat embolism syndrome at autopsy requires analysis of the history, clinical and laboratory findings along with autopsy investigations to determine its relevance, but is an important diagnosis to make which is not always identified clinically. This paper reviews the history, clinical and laboratory findings and diagnosis of fat embolism and fat embolism syndrome at autopsy.
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12
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Agostini T, Perello R. Siliconomas of the lower limb: Tumour-like excision and reconstruction. Indian J Plast Surg 2019; 49:384-389. [PMID: 28216820 PMCID: PMC5288915 DOI: 10.4103/0970-0358.197228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. Objectives: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone. Methods: Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn’t referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a “staging” of siliconoma. Results: Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh's profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared. Conclusions: Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.
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Affiliation(s)
- Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
| | - Raffaella Perello
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
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13
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Liquid Silicone-Induced Extensive and Debilitating Granulomatosis Responding to Hydroxychloroquine. Case Rep Rheumatol 2019; 2019:8173790. [PMID: 31428505 PMCID: PMC6681618 DOI: 10.1155/2019/8173790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022] Open
Abstract
In the last two decades, there has been a significant rise in body-image improvement among the American consumers. Cosmetic injectable procedures have increased by 40.6% in the past 5 years. There has also been an increase in nonmedical, illegal, and self-appointed personnel, offering cheaper hazardous procedures. Silicone has been in use since 1965. In 1991, FDA issued guidelines prohibiting the marketing of injectable liquid silicone. However, it is biologically inert, is associated with inflammatory response, and leads to serious complications like granulomatosis, migration, acute pneumonitis, pulmonary embolism, and even death. Here, we present a case of silicone-induced granulomatosis with extensive migration which ended in bilateral mastectomy, multiple anterior chest debulking procedures, and finally peg tube placement due to compression of the esophageal lumen by granulomas. The patient was eventually started on immunomodulatory treatment, hydroxychloroquine with good response.
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14
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Bertin C, Abbas R, Andrieu V, Michard F, Rioux C, Descamps V, Yazdanpanah Y, Bouscarat F. Illicit massive silicone injections always induce chronic and definitive silicone blood diffusion with dermatologic complications. Medicine (Baltimore) 2019; 98:e14143. [PMID: 30681578 PMCID: PMC6358378 DOI: 10.1097/md.0000000000014143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 12/03/2022] Open
Abstract
Male-to-female transgender (MtF TG) individuals often report using illegal subcutaneous silicone injections for body feminisation. It leads to silicone dissemination and various dermatologic complications.We report the long-term complications of these feminisation procedures with blood smear examination and dermatologic examination.Between July 2015 and December 2015, 77 MtF TG consulting at Bichat Hospital (Paris, France) were included in this cross-sectional study. Blood smear examinations were performed by a trained haematologist to quantify the presence of silicone vacuoles in monocytes.All patients reported a history of massive amounts of silicone injections (mean 4 L, range 0.5-15 L). Most patients were South American (75/77, 97%). Fifty-nine (59/75, 79%) were HIV-seropositive, mostly with undetectable HIV RNA plasma levels (46/58, 80%). Clinical examinations reported dermatologic complications for all patients: lymphatic or subcutaneous migration of silicone (59%), inflammation (50%), varicose veins (39%), post-inflammatory pigmentation (20%), infection (14%) and abscesses (4%). Blood smear examination showed intracytoplasmic vacuoles containing silicone in monocytes in all patients.We did not chemically prove the silicone nature of the vacuoles. The design of this study does not allow evaluation of short-term complications that should not be minimized.Illicit massive silicone injections always induced chronic and definitive silicone blood diffusion with dermatologic complications. This study highlights the dangers and the inefficiency of clandestine esthetic surgery. There is a need for targeted information campaigns with transgender populations about silicone injections. Otherwise, these practices may persist.
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Affiliation(s)
| | - Rachid Abbas
- Biostatistic and Epidemiology Department, Gustave Roussy Hospital, Villejuif
| | | | | | | | | | | | - Fabrice Bouscarat
- Dermatology and CeGIDD, Bichat Hospital, Assistance Publique Hopitaux De Paris, Paris, France
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Martínez-Villarreal AA, Asz-Sigall D, Gutiérrez-Mendoza D, Serena TE, Lozano-Platonoff A, Sanchez-Cruz LY, Toussaint-Caire S, Domínguez-Cherit J, López-García LA, Cárdenas-Sánchez A, Contreras-Ruiz J. A case series and a review of the literature on foreign modelling agent reaction: an emerging problem. Int Wound J 2016; 14:546-554. [PMID: 27488810 DOI: 10.1111/iwj.12643] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/20/2016] [Indexed: 11/29/2022] Open
Abstract
Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.
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Affiliation(s)
- Ashley A Martínez-Villarreal
- Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Daniel Asz-Sigall
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | | | - Thomas E Serena
- Department of Clinical Research, SerenaGroup Wound and Hyperbaric Centers, Cambridge, MA, USA
| | - Adriana Lozano-Platonoff
- Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Lourdes Y Sanchez-Cruz
- Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Sonia Toussaint-Caire
- Section of Dermatopathology, Department of Dermatology, Dr Manuel Gea Gonzalez General Hospital, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Department of Dermatology, "Dr. Salvador Zubirán" National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico
| | - Lirio A López-García
- Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - Andrea Cárdenas-Sánchez
- Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
| | - José Contreras-Ruiz
- Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico
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16
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Pulmonary Empty Spaces: Silicone Embolism-A Decade of Increased Incidence and Its Histological Diagnosis. Case Rep Pathol 2016; 2016:3741291. [PMID: 26904340 PMCID: PMC4745326 DOI: 10.1155/2016/3741291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
Pulmonary embolism (PE) is a critical complication related to multiple disorders and different medical or cosmetic procedures. This case report presents two patients who were admitted for respiratory symptoms in the setting of previously receiving silicone injections for cosmetic purposes and were diagnosed with silicone pulmonary embolism. The relevance of including questions about all cosmetic procedures as a part of a medical history is highlighted, in particular about silicone injections. The diagnosis is confirmed by histological means. Additionally, our review showed the change of most common sites of silicone injections and a significant increase in cosmetic procedures causing silicone embolism during the past twelve years.
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Inayat F, Cheema AR, Virk HUH, Yoon DJ, Farooq S, Manan A. Nonthrombotic Pulmonary Embolism: A Potential Complication of Polyacrylamide Hydrogel Cosmetic Injection. Case Rep Med 2016; 2016:1397434. [PMID: 26884766 PMCID: PMC4738949 DOI: 10.1155/2016/1397434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/24/2015] [Indexed: 12/30/2022] Open
Abstract
Context. Polyacrylamide hydrogel (PAAG) has gained importance as a synthetic soft tissue filling agent. It has been commonly employed by physicians in Europe for facial contouring and soft tissue augmentation. Previously, PAAG is considered nontoxic and well tolerated with a few mild procedural complications. Case Presentation. A 26-year-old female was hospitalized for dry cough, worsening dyspnea, and chest discomfort after 3 hours of multiple PAAG injections in buttocks. The patient's condition deteriorated and rapidly advanced to acute respiratory failure. Therein, the diagnosis of nonthrombotic pulmonary embolism (NTPE) was established on standard set of investigations. She was intubated; corticosteroid and empiric antibiotic therapy was initiated resulting in improvement of her condition. Subsequently, extubation was done, and she was discharged from the hospital after an uneventful recovery. On 1-month follow-up, the patient had no previous symptoms. Conclusion. This report implicates clinicians to maintain a high index of suspicion for NTPE in patients presenting with respiratory symptoms following PAAG usage.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ahmad R. Cheema
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York, NY 10019, USA
| | - Hafeez Ul Hasan Virk
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York, NY 10019, USA
| | - Daniel J. Yoon
- Department of Radiology, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York, NY 10025, USA
| | - Salman Farooq
- Department of Neurology, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Abdul Manan
- Department of Medicine, Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospitals, Icahn School of Medicine, New York, NY 10019, USA
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Abstract
Gallium-67 citrate has long been used for imaging of infection and inflammation. Although gallium-67 uptake due to silicone implants and silicone injections has been previously reported in the literature, very few cases are documented. We report a case of increased gallium-67 uptake in the buttocks in a patient who previously received silicone injections in the buttocks, to reemphasize silicone augmentation as a potential source of gallium-67 uptake. In addition, we present a F-18-fluorodeoxyglucose (FDG) PET/CT scan from the same patient to demonstrate mild diffuse FDG uptake in the buttocks in the region of previous silicone injection. Although FDG is well known to accumulate in areas of inflammation such as prior sites of silicone injection or silicone implantation in the breast, FDG uptake in the buttocks due to silicone injections has not been previously reported or correlated with a gallium scan.
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20
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Rewriting History: Fever of Unknown Origin. Am J Med 2015; 128:956-8. [PMID: 26007673 DOI: 10.1016/j.amjmed.2015.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
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Jang JG, Hong KS, Choi EY. A case of nonthrombotic pulmonary embolism after facial injection of hyaluronic Acid in an illegal cosmetic procedure. Tuberc Respir Dis (Seoul) 2014; 77:90-3. [PMID: 25237381 PMCID: PMC4165666 DOI: 10.4046/trd.2014.77.2.90] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/19/2014] [Accepted: 05/29/2014] [Indexed: 12/11/2022] Open
Abstract
Hyaluronic acid is widely used in medical procedures, particularly in cosmetic procedures administered by physicians or nonmedical personnel. The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause nonthrombotic pulmonary embolism (NTPE). We report the case of a woman with acute respiratory failure, neurologic symptoms and petechiae after an illegal procedure of hyaluronic acid dermal filler performed by an unlicensed medical practitioner 3 days before symptom onset. Although a few cases of NTPE after injection of hyaluronic acid have been reported yet, this is the first typical case showing a NTPE manifestation after the facial injection of hyaluronic acid.
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Affiliation(s)
- Jong Geol Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyung Soo Hong
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Young Choi
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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22
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Duan Y, Zhang L, Li S, Yang Y, Xing J, Li W, Wang X, Zhou Y. Polyacrylamide hydrogel pulmonary embolism--A fatal consequence of an illegal cosmetic vaginal tightening procedure: A case report. Forensic Sci Int 2014; 238:e6-e10. [PMID: 24656776 DOI: 10.1016/j.forsciint.2014.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/14/2014] [Accepted: 02/18/2014] [Indexed: 12/15/2022]
Abstract
Vaginal tightening is a kind of esthetic surgery aimed at enhancing sexual satisfaction during intercourse. Although the injective vaginal tightening procedure is informal, there are already some reports of its application. But pulmonary embolism is a really rare therapeutic complication of this procedure. We report a case of death due to the non-thrombotic pulmonary embolism as a consequence of illegal cosmetic vaginal-tightening procedure using polyacrylamide hydrogel. A 34-year-old woman was hospitalized with paroxysmal abdominal cramps and diarrhea as initial symptoms, while she concealed the genital cosmetic surgery history. Respiratory distress presented only 1.5h before she died. The result of autopsy revealed the cause of death as pulmonary embolism due to the hydrogel which was injected into her vaginal wall. The emboli were confirmed as polyacrylamide hydrogel by Alcian-blue stain and the Fourier transform infrared scanning. It is suggested that pulmonary embolism should not be discarded in the expertise of deaths following cosmetic implant surgeries. It broadens our understanding about death associated with esthetic genital procedures and informs clinicians and medical examiners of the potential death of this type. And detailed investigations of previous medical and surgical history will always play a critical role in the certification of cause of death.
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Affiliation(s)
- Yijie Duan
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Lin Zhang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Shangxun Li
- Department of Public Security of Hubei Province, No.181 Xiongchu Avenue, Wuhan, 430070, PR China.
| | - Yi Yang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Jingjun Xing
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Wenhe Li
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
| | - Xinmei Wang
- Central Hospital of Zibo, No. 54 Gongqingtuan West Road, Zibo, 255036, PR China.
| | - Yiwu Zhou
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College, No. 13 Hangkong Road, Hankou, Wuhan, 430030, PR China.
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23
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Respiratory Disease following Illicit Injection of Silicone: A Case Report. Case Rep Med 2013; 2013:743842. [PMID: 23956752 PMCID: PMC3727130 DOI: 10.1155/2013/743842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 06/23/2013] [Indexed: 11/18/2022] Open
Abstract
Unregulated, pseudomedical procedures risk serious sequelae even when otherwise safe compounds are used. Silicone is commonly used legally in cosmetic procedures owing to its durability, resistance to heat and aging, and low immunogenicity. However, inappropriate or illegal silicone injection can pose severe local and systemic complications including serious pulmonary compromise. We describe the case of a 30-year-old female who presented with hemoptysis and progressive shortness of breath following illicit silicone injections to the gluteal fat and was found to have new, diffuse, bilateral, ground-glass opacities on contrast-enhanced pulmonary computed tomography. Transbronchial biopsy elucidated that this was a lipoid pneumonia-type injury secondary to silicone infiltration.
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Pedrozo Pupo JC. Pulmonary Interstitium. LEARNING CHEST IMAGING 2013. [PMCID: PMC7120621 DOI: 10.1007/978-3-642-34147-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The first step in the radiographic evaluation of interstitial lung disease begins with a fundamental knowledge of the anatomy of the pulmonary interstitium and the different patterns of disruption. The anatomy of the pulmonary interstitium as demonstrated on CT of the chest with high resolution cuts is largely essential to establish the various radiological patterns that define interstitial lung disease such as the tree-in-bud, ground-glass opacity, crazy -paving, etc.
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Affiliation(s)
- John C. Pedrozo Pupo
- , Institute for Respiratory Care, University of Magdalena, Cra 21 Nr. 18-27, Santa Marta, 470004 MAGDALENA Colombia
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Hariri LP, Gaissert HA, Brown R, Ciaranello A, Greene RE, Selig MK, Kradin RL. Progressive Granulomatous Pneumonitis in Response to Cosmetic Subcutaneous Silicone Injections in a Patient With HIV-1 Infection: Case Report and Review of the Literature. Arch Pathol Lab Med 2012; 136:204-7. [DOI: 10.5858/arpa.2011-0149-cr] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Silicone, commonly used in cosmetic procedures owing to its presumed inertness, can yield serious sequelae including acute embolization and pneumonitis. Chronic pulmonary sequelae in response to silicone injection have not been previously described. We report a case of chronic progressive granulomatous pneumonitis in response to subcutaneous silicone injections in a transgender male-to-female patient infected with human immunodeficiency virus 1 (HIV-1). After receiving silicone injections to the buttock, the patient developed rapid onset dyspnea, pleuritic chest pain, fever, and chills. Chest computed tomography revealed diffuse peripheral interstitial opacities. She responded symptomatically to prednisone with subsequent intermittent symptomatic flares. Four years later, she developed marked dyspnea and cough. Chest computed tomography showed progressive diffuse ground-glass and nodular opacities. Lung biopsies demonstrated numerous spheroid silicone particles within the lung interstitium and small pulmonary vessels, surrounded by foreign body giant cells and nonnecrotizing granulomatous inflammation. We speculate that HIV-1–infected patients may be at risk for chronic, progressive granulomatous pneumonitis due to silicone injection years after their procedure owing to shifting levels of cell-mediated immunity.
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26
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Mongero LB, Brodie D, Cunningham J, Ventetuolo C, Kim H, Sylvin E, Bacchetta MD. Extracorporeal membrane oxygenation for diffuse alveolar hemorrhage and severe hypoxemic respiratory failure from silicone embolism. Perfusion 2010; 25:249-52; discussion 253-4. [DOI: 10.1177/0267659110375327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liquid silicone is an inert material that may be used for cosmetic procedures by physicians as well as illegally by non-medical personnel. The use of silicone may result in severe complications, disfigurement, and even death. In addition, the indications for extracorporeal membrane oxygenation (ECMO) support have been increasing as a salvage therapy for a variety of life-threatening conditions. The patient is a 27-year-old woman with no significant medical conditions who developed silicone emboli, and subsequent diffuse alveolar hemorrhage after being injected with silicone in her gluteal region without medical supervision. She became profoundly hypoxemic and suffered a brief asystolic cardiac arrest in this setting. The patient was placed on veno-venous ECMO support for 14 days. Medical care during ECMO was complicated by pulmonary hemorrhage, hemothorax, pneumothorax, and blood clot, resulting in oxygenator change-out. A modified adult ECMO circuit (Jostra QuadroxD, Maquet Cardiopulmonary, Rastatt, Germany) was used to transport the patient from a nearby community affiliate hospital and then reconfigured for the medical intensive care unit on a standard HL-20 heart-lung console. Although the use of ECMO for severe hypoxemic respiratory failure has been widely reported, to our knowledge, this is the first reported successful use of ECMO for silicone embolism syndrome associated with diffuse alveolar hemorrhage and severe hypoxemic respiratory failure.
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Affiliation(s)
- LB Mongero
- Department of Clinical Perfusion, New York Presbyterian MC/Columbia University Medical Center, New York, NY, USA,
| | - D. Brodie
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - J. Cunningham
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - C. Ventetuolo
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - H. Kim
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - E. Sylvin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - MD Bacchetta
- Department of Surgery, Cardiothoracic Division, New York Presbyterian MC/Columbia University Medical Center, New York, NY, USA
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Abstract
An unlicensed practitioner performing subcutaneous injections of large volumes of corn oil caused the death of one of her clients and life-threatening neurologic complications of a second client from systemic fat embolism. Several additional clients also came forward to report other serious complications they had suffered from similar procedures. The clinicopathologic and investigative findings from these cases are described. In both instances of fat embolization, the diagnosis was overlooked by hospital staff because of insufficient or misleading clinical history. The local and systemic pathologic manifestations of corn oil injections in 1 victim who died several days later from multiple organ failure are described. The clinical history and course of another who survived after 8 days of hospitalization are also presented. Similarities with complications from other forms of cosmetic oil injections are discussed. Laboratory analyses applied to confirm the nature of the injected oil and the course of criminal prosecution are also described.
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29
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Pneumonitis caused by silicone gel following breast implant rupture. Ir J Med Sci 2009; 179:141-5. [PMID: 19565317 DOI: 10.1007/s11845-009-0369-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 05/14/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There have been reports of pneumonitis associated with subcutaneous injection of liquid silicone, and of other pulmonary conditions due to cohesive silicone gel prostheses, but we know of no previous cases of pneumonitis associated with silicone gel. MATERIALS AND METHODS We report the case of a patient with a cohesive silicone gel mammary prosthesis in whom silicone-induced pneumonitis was diagnosed following radiological observation of pulmonary infiltrates and tests including transbronchial biopsy, which revealed the presence of silicone in alveolar histiocytes and small blood vessels. CONCLUSION Following removal of the ruptured prosthesis and a course of systemic corticoids, the patient progressed favourably.
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