Vieira Gomes Catia, Coquoz Nicolas, Vervier Jeanne, Yerly Stephane, Bridevaux Pierre-Olivier
Pneumology, Centre Hospitalier du Valais Romand, Sion, Switzerland
Université de Genève, Geneve, Switzerland.
BMJ Case Rep. 2025 Jan 21;18(1):e263676. doi: 10.1136/bcr-2024-263676.
A woman in her mid-70s presented with worsening dyspnoea, cough and fatigue initially treated for pneumonia. Despite antibiotics, her condition deteriorated, prompting further investigation. Medical history included previous breast implants, the latter of which had ruptured years earlier and was subsequently removed prior to the current presentation. Imaging revealed bilateral lung consolidations and lymphadenopathy. Bronchoalveolar lavage indicated macrophagic alveolitis, while biopsies showed chronic inflammation and the presence of silicone. Diagnosis of chronic pulmonary silicone embolism was made, a rare condition linked to the migration of silicone particles into the lungs, causing inflammation. Treatment involved corticosteroids, leading to symptom resolution. This case highlights the diagnostic challenges of silicone pneumonitis, which can manifest years after implant rupture and removal. Clinicians should be aware of this condition to avoid misdiagnosis and delayed treatment, as symptoms may persist even after implant removal due to irreversible lung fibrosis.
一名75岁左右的女性因呼吸困难、咳嗽和疲劳加重前来就诊，最初被诊断为肺炎并接受治疗。尽管使用了抗生素，她的病情仍恶化，促使进一步检查。病史包括既往隆胸手术，其中隆胸假体多年前已破裂，在本次就诊前已取出。影像学检查显示双侧肺部实变和淋巴结肿大。支气管肺泡灌洗显示巨噬细胞性肺泡炎，活检显示慢性炎症和硅酮的存在。诊断为慢性肺硅酮栓塞，这是一种罕见的疾病，与硅酮颗粒迁移至肺部并引起炎症有关。治疗采用了皮质类固醇，症状得以缓解。该病例突出了硅酮肺炎的诊断挑战，这种疾病可能在植入物破裂和取出数年之后才出现症状。临床医生应了解这种疾病，以避免误诊和延误治疗，因为即使在植入物取出后，由于不可逆的肺纤维化，症状可能仍然持续。
