Pneumotox » Drug » Silicone, fluid

Silicone, fluid

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Fluid silicone is used by cosmetic surgeons or by illegal 'lay' surgeons, or by incompetent and unscrupulous operators (PMID; 16738424) for the purpose of body augmentation mammaplasty (then in the breasts) or in the context of transsexualism. The compound may cause severe or fatal silicone embolism syndrome with DAH, ARDS and/or MODS

Last update : 25/02/2022

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

2

I.b Pneumonitis (ILD)

1

I.k Lung nodule or nodules

1

I.z An area or areas of consolidation

2

I.al Silicone pneumonitis - 'Silicone lung'

3

II.b ARDS - Acute lung injury

2

II.u Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

1

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

2

VI.m Silicone pulmonary embolism (SE) - SE syndrome

4

VII.k Mediastinal silicone infiltration/siliconoma

1

VIII.k Submucosal airway petechiae/hemorrhage

1

X.u Multiple organ dysfunction/failure (MODS/MOF)

1

XI.b Chest pain (acute or subacute), lone or prominent

2

XI.aa CNS symptoms or involvement, stroke

1

XI.bn A restrictive lung function defect

1

XI.bo Parietal chest involvement

1

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

1

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

1

XV.g Path: Alveolar hemorrhage (see also IIIa)

2

XV.l Path: Pulmonary fibrosis (not otherwise specified or unclassifiable)

1

XV.bn Path: Silicone droplets/vacuoles in lung tissue, pulmonary vasculature, or lymph nodes

2

XV.bo Path: Siliconoma

1

XV.cw Path: Silicone pulmonary embolism

2

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

2

XVI.e Imaging: Pulmonary opacities with a subpleural distribution

1

XVI.ax Imaging: Foreign body pulmonary embolism

3

XVI.bh Imaging: F18-PET scan positive lympadenopathy

1

XIX.d BAL: Gross or microscopic bleeding/hemorrhage

1

XIX.l BAL: Silicone globules in macrophages

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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