CTICasesAcute Lung Injury with Silicone Lymphadenopathy (Possible Silicone Embolization)
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Imaging findings
Rapidly progressing air-space opacification with bronchograms and peripheral/basilar predominance on chest radiographs, leading to intubation. CT showed diffuse airspace opacity, dependent consolidation, anterior ground glass, and early traction bronchiectasis, consistent with ARDS. Massive lymphadenopathy was present in the axillary and paratracheal regions. Breast ultrasound indicated a contained implant rupture, and axillary lymph nodes displayed high echogenicity, characteristic of silicone. Blood work showed no eosinophilia, and microbiology/serology were unremarkable.
Key takeaways
This case presented as severe acute lung injury in a young, healthy female with significant silicone lymphadenopathy from breast implant rupture. It was postulated that the incident (possibly water skiing) caused a large volume silicone leak, leading to silicone embolization and pneumonitis, for which case reports exist. Another possibility was an acute hypersensitivity reaction to fertility treatment injections containing sesame seed oil. The characteristic ultrasound appearance of silicone-laden lymph nodes was a striking finding.
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