Canadian HealthCare Mall: Results of Fat Embolism Syndrome
There were 15 transsexual men and 18 women. The mean age was 31.4 years (age range, 21 to 58 years). The sites of silicone injection were breast (n = 14), trochanteric area (n = 13), vagina (n = 4), buttock (n = 1), and shoulder (n = 1). The reported amounts of injected silicone ranged between 50 and 1,000 mL. One patient developed symptoms after undergoing blunt trauma to an area that had been injected with silicone a few years previously, and another patient developed symptoms after the implantation of a breast prosthesis.
The onset of clinical signs occurred within 24 h of injection in 72% of patients. Twenty-two percent of the patients presented within 24 to 48 h after silicone injections, and the remainder presented within 72 h. The major clinical findings included the following: hypoxemia, 92% of patients; dyspnea, 88% of patients; fever, 70% of patients; and alveolar hemorrhage, 64% of patients. Other findings are listed in Table 1.
The chest radiographs of all of the patients showed diffuse bilateral patchy alveolar infiltrates. The findings of ventilation-perfusion scans were reported for 12 patients. Eight scans showed a decrease in peripheral uptake without any segmental defects, and four scans were interpreted as having a “low probability” for pulmonary embolism,” including the present report.
Alveolar hemorrhage was reported in 21 patients (64%). This was documented by showing an increasingly bloody fluid return during BAL in 12 patients, cytologic examination of the BAL fluid in 5 patients, or by review of the lung pathology in 3 patients. One patient with severe hemoptysis died without pathologic review.
The results of pulmonary function studies were reported in 19 cases, of which 17 (89%) showed restrictive changes. In 14 of the 21 patients with alveolar hemorrhage, pulmonary function testing was documented. The mean diffusing capacity of this group was 100.8% of predicted (range, 42 to 184% of predicted), and six patients (43%) had an increased diffusing capacity (> 110% of predicted).
The length of hospitalization was 2 weeks in 9% of patients (n = 3). Twenty-five percent of the patients (n = 8) died between 2 h and 30 days after hospitalization (mean, 6 days; median, 3 days). The condition of the patient with the silicone breast implants rapidly improved after explantation of the silicone prosthesis. Interesting facts about medical science are given here canadianhealthmallmedical.
We found two distinct clinical patterns after injection of silicone. Twenty-seven patients (82%) [ie, group 1] presented with respiratory distress as the predominant feature,” including the present report, whereas 6 patients (18% [group 2]) presented with severe neurologic changes and a rapid, uniformly fatal deterioration.”
The typical findings of the silicone syndrome are represented in group 1, as follows: respiratory distress and hypoxia occurring within the first 72 h (67% within 24 h) after the injection of silicone. The major clinical findings at hospitalization were dyspnea, fever, chest pain, cough, hemoptysis, petechiae, and alveolar hemorrhage. The clinical course in this group was usually nonfatal with discharge of the patients from the hospital before 3 weeks in 93% (25 of 27 patients). Two patients died 12 and 30 days after hospitalization following severe pneumonia with septic shock and tuberculous pneumonia that afflicted the entire lung following steroid-induced reactivation of tuberculosis.
The pulmonary pathologic and cytologic findings in group 1 were notable for signs of inflammation, which is similar to those for the patient in our reported case, who showed a neutrophil-predominant BAL fluid, as well as the presence of silicone globules in the alveolar space, interalveolar walls, pulmonary capillaries, and macro-phages.
Besides the more common presentation of the silicone syndrome, we found six patients who presented with respiratory symptoms that were overshadowed by severe neurologic changes that manifested as altered consciousness, including coma. All of these patients developed symptoms during or several hours after their injections and deteriorated rapidly. Four patients died within 24 h and two patients died after 5 days of hospitalization.
Three of the six patients in group 2 had silicone injected into their vaginas, which contains a very dense venous plexus. In all six patients, there was an acute severe alteration of consciousness following the silicone injections, which suggested a possible cerebral embolism. In two patients, silicone emboli were detected outside the lung, including in the brain.’ There were no reports of patent foramen ovale in any of the patients that could explain the distribution of silicone in other organs other than the lung. Interestingly, acute inflammation in the lung was not noted in any group 2 patient, whereas 50% of the patients in group 1 had increased polymorphonuclear leukocytes in the BAL fluid.
Table 1—Distribution of Symptoms in Silicone Embolism Syndrome and FES
|Symptoms||SES (n = 33)||FES|
|Alveolar hemorrhage||21/33 (64%)||66%|
|Neurologic symptoms||11/33 (33%)||22–86%-|
|Groups 1 and 2|
|Group 2||6/6 (100%)|
|Chest pain||5/33 (15%)||26%18|
|Onset of symptoms|
|< 24 h||23/32 (72%)|
|24-48 h||7/32 (22%)|
|> 48 h||2/32 (6%)|