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Lethal silicone embolization syndrome complicating penile, scrotal and breast self-augmentation

  • Steven Wills
  • Roger W. ByardEmail author
Images in Forensics

Abstract

A 62-year-old man died following injection of liquid silicone into his external genitalia and chest wall. The body was discovered naked, apart from a pair of black women’s high-heeled shoes, black ankle restraints, which were chained together, and disposable medical gloves. Medical items in the house included syringes, needles, alcohol wipes and unmarked/labelled empty brown glass medical bottles. At autopsy the external genitalia were markedly enlarged with white dressings over injection sites in the scrotum, penis and above the left nipple. Histological examination of the scrotum, penis and breast showed a florid granulomatous foreign body giant cell reaction and scarring surrounding numerous optically clear vacuoles. The lungs also showed numerous vacuoles within the interstitium in keeping with embolization of injected material. Death was due to silicone embolization. Despite the dangers of liquid silicone injections for soft tissue augmentation, and the ban on its use for medical cosmetic procedures, this practice continues.

Keywords

Silicone Injection Scrotal augmentation Granulomatous inflammation Silicone embolization 

References

  1. 1.
    Silberstein J, Downs T, Goldstein I. Penile injection with silicone: case report and review of the literature. J Sex Med. 2008;5:2231–7.CrossRefGoogle Scholar
  2. 2.
    Callahan EP, Zautcke J. Unusual cause of scrotal abscess. Ann Emerg Med. 1991;20:710.CrossRefGoogle Scholar
  3. 3.
    Summers JA. A complication of an unusual sexual practice. South Med J. 2003;96:716–7.CrossRefGoogle Scholar
  4. 4.
    Yoganathan KG, Blackwell AL. Unusual causes of acute scrotal cellulitis in an HIV positive man. Sex Trans Infect. 2006;82:187–8.CrossRefGoogle Scholar
  5. 5.
    Chasan PE. The history of injectable silicone fluids for soft-tissue augmentation. Plast Reconsttruct Surg. 2007;120:2034–40.CrossRefGoogle Scholar
  6. 6.
    Ellenbogen R, Ellenbogen R, Rubin L. Injectable fluid silicone therapy. Human morbidity and mortality. JAMA. 1975;234:308–9.CrossRefGoogle Scholar
  7. 7.
    Dewan PA, Stefanek W, Byard RW. Long-term histological response to intravenous teflon and silicone in a rat model. Pediatr Surg Int. 1995;10:129–33.Google Scholar
  8. 8.
    Dewan PA, Owen AJ, Ashwood PJ, Terlet J, Byard RW. An in vitro study of silicone migration from intravenous fluid tubing. Pediatr Surg Int. 1997;12:49–53.CrossRefGoogle Scholar
  9. 9.
    Bartsich S, Wu JK. Silicon emboli syndrome: a sequela of clandestine liquid silicone injections. A case report and review of the literature. J Plast Recon Aesth Surg. 2010;63:e1–3.CrossRefGoogle Scholar
  10. 10.
    Rollins CE, Reiber G, Guinee DG, Lie JT. Disseminated lipogranulomas and sudden death from self-administered mineral oil injection. Am J Forensic Med Pathol. 1997;18:100–3.CrossRefGoogle Scholar
  11. 11.
    Shamsodini A, Al-Ansari AA, Talib RA, Alkafaji HM, Shokeir AA, Toth C. Complications of penile augmentation by use of nonmedical industrial silicone. J Sex Med. 2012;9:3279–83.CrossRefGoogle Scholar
  12. 12.
    Byard RW, Bramwell NH. Autoerotic death. A definition. Am J Forensic Med Pathol. 1991;12:74–6.CrossRefGoogle Scholar
  13. 13.
    Byard RW, Eitzen DA, James R. Unusual fatal mechanisms in nonasphyxial autoerotic death. Am J Forensic Med Pathol. 2000;21:65–8.CrossRefGoogle Scholar
  14. 14.
    Restrepo CS, Artunduaga M, Carrillo JA, Riveras AL, Ojeda P, Martinez-Jimenez S, et al. Silicone pulmonary embolism: report of 10 cases and review of the literature. J Comput Assist Tomogr 2010;33:233–7.Google Scholar
  15. 15.
    Schmid A, Tzur A, Leshko L, Krieger BP. Silicone embolism syndrome: a case report, review of the literature, and comparison with fat embolism syndrome. Chest. 2005;127:2276–81.CrossRefGoogle Scholar
  16. 16.
    Lyapichev K, Chinea FM, Poveda J, Pereda J, Bejarano PA, Garcia-Buitrago MT. Pulmonary empty spaces: silicone embolism – a decade of increased incidence and its histological diagnosis. Case Rep Pathol. 2016;2016:3741291.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Lewin-Smith M, Kalasinsky V, Shilo K, Tomashefski J, Cropp A. Detection of silicone in lung tissue. Arch Path Lab Med. 2012;136:1179–80.CrossRefGoogle Scholar
  18. 18.
    Sepehripour S, Filobbos G, Drake M, Orlando A. Scrotal siliconoma: complications of an unapproved substance to an uninformed public. BMJ Case Rep. 2013;2013.  https://doi.org/10.1136/bcr-2012-008122

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Forensic Science SAAdelaideAustralia
  2. 2.School of MedicineThe University of AdelaideAdelaideAustralia

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