CTICasesPulmonary Silicone Granulomatosis
Imaging findings
A 59-year-old with bilateral breast implants (and surgical clips in the right axilla) has clustered, somewhat perilymphatic nodules along the fissures, with a possible galaxy sign, that have slowly grown over 10 to 12 years without lymphadenopathy. History revealed a ruptured right silicone implant during a 1990s axillary node biopsy with silicone-containing nodes excised. CT-guided core biopsy showed a giant-cell foreign-body reaction to material consistent with silicone.
Key takeaways
Chronic silicone granulomatosis can produce slowly enlarging clustered perilymphatic pulmonary nodules years after implant rupture, mimicking sarcoidosis, hyalinizing granuloma, or epithelioid hemangioendothelioma. Unlike acute silicone embolization syndrome, this chronic granulomatous reaction is uncommon, and the upper-lung predominance here is unexplained given the expected hematogenous (lower-lobe) distribution.
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