A 24 year old female from Europe presents with progressive shortness of breath and hemoptysis. O2 sat is 94%. CXR is clear. PSH includes silicone implants in gluteal area. Meds include OCPs. Travel from Eastern Europe 2 months ago. D-dimer is negative. CTA is negative for embolus. What is the diagnosis?
Answer: Silicone Pneumonitis
CTA (the patient whose CTA images are below also had x-ray findings):
– Liquid silicone implanting is an unregulated industry with many reported complications, more commonly from abroad
– For silicone pnuemonitis, d-dimer may be positive or negative and CTA usually reveals ground-glass opacities
– Silicone pneumonitis usually responds well to steroids. Patients may also feel better with bronchodilator therapy.
– For silicone emboli, d-dimer may also be negative. Silicone emboli have a mortality of 24% in some reports and do not have a clear treatment except supportive care and surgical resection of embolus.