CTICasesChest Wall Injection Granulomatosis with Hypercalcemia
Imaging findings
CT of the chest demonstrates extensive soft-tissue calcification, inflammatory stranding, and multiple low-attenuation, lipid-rich globule-like masses throughout the bilateral anterior chest wall and breast tissue. There is a complete absence of the pectoralis muscles bilaterally, consistent with a prior history of radical bilateral mastectomies. The lungs demonstrate severe lower-lobe predominant emphysema.
Key takeaways
Illicit or cosmetic injection of free silicone, mineral oil, or paraffin into the breast and chest wall tissue can lead to a severe chronic inflammatory and granulomatous foreign body reaction, known as injection granulomatosis. This chronic granulomatous reaction can occasionally lead to systemic hypercalcemia, mediated by the extra-renal production of 1,25-dihydroxyvitamin D (calcitriol) by activated macrophages within the granulomas, analogous to the mechanism of hypercalcemia in sarcoidosis.
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