Silicone that has been injected for a variety of reasons can enter the venous system and reach the lungs. If it arrives in small particles then pneumonitis occurs. If it arrives in a large bolus then the patient presents with a pulmonary embolism.
Acute features:
(1) pulmonary embolism
(2) pneumonitis with alveolar hemorrhage
(3) sudden death
Late complications:
(1) pulmonary fibrosis
Diagnosis:
(1) history of recent or remote silicone injections
(2) presence of silicone in biopsy material, usually associated with a foreign body type giant cell reaction
(3) exclusion of other causes (see below)
Differential diagnosis:
(1) fat embolism (Schmid et al report that the Schonfeld score for the fat embolism syndrome is predictive of outcome after silicone injection)
(2) pulmonary embolism secondary to deep vein thrombosis
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