Silicon 주사후 발생한 폐색전증 2예

Two Cases of Silicone-induced Pulmonary Embolism

저자들은 colporrhaphy를 목적으로 실리콘 피하주사 후 호흡곤란을 주소로 내원한 2명의 환자에서 기관지폐포세척액 검사, 경기관지 폐생검, 고해상 컴퓨터 단층촬영, 폐동맥조영술 등을 시행하여 폐색전증으로 인한 급성호흡부전으로 진단하고 지지요법만으로 치료한 1예와 사망한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Silicone (polydimethylsiloxane) has widely been used in breast augmentation and other cosmetic procedures. Despite the stability of its chemical nature, local and systemic adverse reactions associated with silicone have been reported. There were several patients who suffered from pulmonary embolism associated with injection of silicone. Silicone-induced pneumonitis and sudden death after subcutaneous injection of silicone has been also described. However, there is no case in the literature of clinically diagnosed silicone-induced pulmonary embolism in Korea. We experienced 2 women who developed respiratory symptoms after illicit subcutaneous injection of silicone for the purpose of colporrhaphy. One patient was admitted because of dyspnea, chest pain, hemoptysis and bilateral pulmonary infiltration after repeated injection of silicone. Pulmonary function test initially showed severe restrictive pattern and transbronchial lung biopsy disclosed numerous oil-like material filling the alveolar septal capillaries and macrophages. High resolution C. T., bronchoalveolar lavage, transbronchial lung biopsy and pulmonary angiogram disclosed abnormalities compatible with silicone fluid-induced pulmonary embolism. The other patient expired shortly after arrival in the emergency room. It is suggested that illicit injecion of silicone fluid carries serious respiratory problems and can induce pulmonary embolism followed by acute respiratory failure.