Pneumotox » Drug » Breast implants - Augmentation mammaplasty (w/wo evidence for leakage/rupture)

Breast implants - Augmentation mammaplasty (w/wo evidence for leakage/rupture)

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Silicone implants may rupture and cause reaction in the adjacent tissue, lymph nodes, in the pleural space or in distant or remote organs and tissues. Silicone implant rupture can cause silicone pleural effusion, migration pneumonitis and/or the silicone implant incompatibility syndrome (SIIS) with dysimmunity (PMID 23576058). Breast implant-associated anaplastic large cell lymphoma cases are increasingly described

Last update : 19/07/2021

I.b Pneumonitis (ILD)

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

I.n Pulmonary alveolar proteinosis (PAP)

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I.al Silicone pneumonitis - 'Silicone lung'

1

I.am Siliconoma

1

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)

1

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

1

V.v Silicone pleural effusion

1

V.w Silicone pleural nodules - Pleural siliconomas

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VII.a Lymphadenopathy (intrathoracic)

1

VII.e Granulomatous mediastinal lymphadenopathy

1

X.e Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

1

X.h Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

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X.j Myopathy-Myositis-Polymyositis (see also under Xba)

1

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

1

X.m Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

1

X.q Systemic inflammatory response

1

X.s Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

1

X.ad Skin purpura, ecchymoses or necrosis

1

XII.c Pericardial effusion (w/wo tamponade)

1

XIII.f Fibromatosis of the chest wall

1

XIII.h Pulmonary nodular lymphoid hyperplasia

1

XIII.i Breast implant-associated anaplastic large cell lymphoma

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XV.m Path: Lymphoid hyperplasia (including nodular- or a lymphocytic interstitial pneumonia pattern)

1

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

1

XV.cq Path: Silicone lymphadenopathy

1

XV.cr Path: Silicone pleural nodules or siliconoma (See under Vw)

1

XVI.k Imaging: An area or areas of consolidation

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XVI.av Imaging: Displacement/migration of a breast implant

1

XVI.bh Imaging: F18-PET scan positive lympadenopathy

1

XVIII.c Eye catcher: A displaced breast implant

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Diagnosing DIRD

1

Drug and radiation history

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Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

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

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Careful exlusion of another cause

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Remission of symptoms with removal of drug

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Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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