These facilitated a progressively rapid decline in her clinical course. pumping party. She arrived with the intention of injecting 3000 ccs of hospital grade silicone into her thighs and buttocks, with lesser quantities for her friends who had previously received silicone injections without complications. Approximately 4 h after administration of the injections she began to experience chest tightness with mild dyspnea and was taken to the ER. On physical examination, BIO-32546 the patient was in no distress while breathing room air. Vital signs were normal. The lungs, heart, and abdominal examinations revealed no abnormalities. The extremities demonstrated extensive bilateral greater trochanteric swelling without erythema with a palpable doughy consistency. Neurologic examination revealed no focal deficits. Laboratory data including complete blood count, serum chemistry, cardiac enzymes and urine for toxicology screening were all negative. Initial electrocardiogram was normal and chest radiographs showed diffuse interstitial infiltrates and minimal pulmonary vascular congestion (Fig. 1). == Fig. 1. == Initial chest radiograph showing diffuse interstitial infiltrates and minimal pulmonary vascular congestion. Ninety minutes later, she became lethargic, markedly dyspneic and diaphoretic. Arterial blood gas analysis on 100% oxygen were pH BIO-32546 7.29, pCO2 37 mmHg, pO2 53 mmHg, and oxygen saturation 82%. She was intubated and transferred to the ICU. Chest CT revealed subcentimeter non-calcified pulmonary nodules, peripheral ground-glass opacities and interlobular septal thickening in all lung lobes (Fig. 2). == Fig. 2. == Chest CT showing subcentimeter pulmonary nodules, peripheral ground-glass opacities and interlobular septal thickening in all lung lobes. What is the diagnosis? == 2. Discussion == Silicone embolism syndrome (SES) is a potentially fatal, multisystemic complication that results from the illegal cosmetic injection of liquid silicone (polydimethylsiloxane). Although silicone polymers were favored for use in cosmetic procedures (Fig. 3) as they were previously believed to be immunologically inert compounds with high thermal stability and minimal tissue reaction,1there is increasing evidence showing a widespread inflammatory reaction to its administration.2 == Fig. 3. == A Pelvic CT coronal slice depicting areas of silicone injection into the gluteal and trochanteric areas bilaterally. Beyond the occurrence of direct intravascular injection which frequently occurs in illicit cosmetic silicone administration, embolic phenomena can also occur as a result of silicone penetration into the microvasculature in the setting of increased BIO-32546 perivascular tissue pressure. The majority of adverse effects are seen in the pulmonary system with a spectrum of events ranging from acute silicone pneumonitis (usually characterized by fever, respiratory insufficiency and bilateral interstitial infiltrates on chest radiographs) to silicone-induced embolic phenomena. These are associated with vascular congestion and hypersensitivity pneumonitis resulting in extensive diffuse alveolar damage and ultimately ARDS.3Most patients develop clinical signs within the first 24 h of silicone administration and the onset of symptoms has been linked to a higher mortality rate (20%).4The most frequent symptoms include hypoxemia, dyspnea, fever, chest pain, cough and hemoptysis.1Bronchoalveolar lavage (BAL) commonly reveals alveolar hemorrhage, and a restrictive pattern is usually observed on pulmonary function studies. While the acute presentation is typical for the majority of patients, delayed-onset pneumonitis and injection-site inflammation occurring years after silicone administration has been described. Migration of micro-droplets of silicone could also assume a delayed presentation in BIO-32546 the form of pulmonary fibrosis.4Occasionally, pulmonary toxicity BIO-32546 has been described to lag behind CNS manifestations especially when initial upper body radiography and pulmonary examinations are benign in the current presence of lethargy. Increasing launch of silicon emboli from the foundation leads to a slow development Rabbit Polyclonal to GCVK_HHV6Z to ARDS like the manifestation of heroin induced pulmonary edema.5Neurologic sequelae of silicone embolism change from gentle alteration in degrees of consciousness to frank coma. Oddly enough, the lack of root cardiac septal problems will not preclude the event of neurologic manifestations, as microinfarcts in.