Recognizing intraventricular silicone

Cytologic features of a pleural effusion after silicone breast implant rupture

Pleural effusion is an extremely rare complication of ruptured breast silicone implants. Rupture may be related to a recent trauma or occur spontaneously, making its diagnosis more difficult. In the few reported cases, cytology did not play a relevant role in its diagnosis. We describe and illustrate a silicone foreign body reaction in a pleural effusion. Cytologic findings were so remarkable as to permit a specific diagnosis. The patient, a 37-year-old female with a history of previous bilateral breast implant surgery was admitted because of a pleural effusion. Computed tomography scan showed a left effusion with secondary atelectasis and bilateral breast rupture with lymph node "siliconomas." Cytologic analysis of the effusion showed well-defined droplets or globules of transparent material, in addition to a microvacuolized background. Where abundant silicone droplets induced a staining artifact of the smears. These were cellular with numerous macrophages containing large vacuoles displacing the nuclei to the periphery. Some had a signet cell ring appearance, while others showed multinucleation. Flow cytometry revealed a predominant macrophagic cell population. With the increasing use of silicone breast implants, rare complications such as pleural effusion may become more common. The pathologist must consider this possibility when extracellular transparent droplets or evidence of a foreign body-type reaction are present. The artifact appearance of the smears may help to suspect it. This rare complication must be always considered when evaluating effusions in patients with silicone breast implants.

Moving silicone oil particles in the ventricle: a case report and updated review

Background

The movement of intraventricular silicone oil observed in the supine position is extremely rare. Herein, we describe a patient who presented with dynamically moving silicone oil particles in the ventricle when changing position and provide an updated review of this phenomenon.

Case presentation

We report a case of a 70-year-old woman who presented with intraventricular hyperdensities that were occasionally found on brain computed tomography (CT). Initial nonenhanced brain CT demonstrated nondependent hyperdensities in the bilateral anterior horns of the lateral ventricles, the third ventricle, and the right suprasellar cistern, mimicking an intraventricular hemorrhage. Further brain magnetic resonance imaging (MRI) in the supine position revealed abnormal signals in the bilateral anterior horns of the lateral ventricles, the posterior horn of the right lateral ventricle, the third ventricle, the right suprasellar cistern, and the bilateral eyeballs, with isosignal intensities surrounded by low-signal chemical shift artifacts on T₁-weighted imaging and variable signals (hypo- or hyperintensity) on T₂-weighted imaging. The lesion in the anterior horn of the right ventricle largely moved to the posterior horn of the ipsilateral ventricle. The final craniocervical CT angiography showed that the lesion in the posterior horn had moved back to the anterior horn of the right lateral ventricle. These features were consistent with intraventricular silicone oil migration. The final spinal MRI did not demonstrate a migration of silicone oil into the spinal subarachnoid space.

Discussion and conclusions

This case report describes a dynamic process of silicone oil displacement in the supine position and provides a comprehensive imaging presentation. The moving pattern and a characteristic chemical shift artifact on MRI are key to the diagnosis and may help prevent unnecessary examinations or intervention.

Intraocular silicone oil brain migration associated with severe subacute headaches: a case report

Purpose

The aim of this article is to report a rare case in which a patient presented symptomatic silicon oil brain migration, documented by MRI, several years after vitreoretinal surgery.

Methods

This is a case report with a prospective literature review.

Patients

The patient described in the case report.

Results

Case report.

Discussion/conclusions

For several years, silicone oil (SiO) has been widely used as a long-term intravitreal tamponading agent to treat complex retinal detachments. There are rare reports in the literature demonstrating the migration of SiO into the brain. The aim of this article is to report a rare case in which the patient presented severe headaches several years after vitreoretinal surgery, with migrated SiO appearing in MRI as an oval lesion within the horn of the right lateral ventricle. To the best of our knowledge, there are very few reports of symptomatic SiO brain migration in the literature.

Extraocular silicone oil migration to orbit and retrolaminar region: case report and systematic review

BACKGROUND

Silicone oil insertion is a common modality in vitreoretinal surgeries. The purpose of this study is to conduct a systematic review to summarize the uncommon complication of extraocular silicone oil migration.

METHODS

Following the PRISMA guidelines, a systematic review of the literature was performed on January 11, 2020, using PubMed and EMBASE with the following terms: "silicone oil," "eye," and "migrat*."

RESULTS

A total of 69 patients-68 patients from 59 articles and one case from our institution-were included in the final analysis. The median age was 54 years (range, 9-92) and 40 patients (57.9%) were men. Orbital migration was reported in 34 patients, and retrolaminar migration (including optic nerve, optic chiasm, suprasellar, subarachnoid space, intraventricular spaces) was reported in 35 patients. Orbital migration group had more aphakics (p = 0.007), implanted glaucoma drainage device (p = 0.005), scleral buckle (p = 0.000), history of trauma-related indications for pars plana vitrectomy (p = 0.000), shorter silicone oil endotamponade time (p = 0.008), more symptomatic (p = 0.000), and requiring surgical intervention (p = 0.000). Retrolaminar migration group had older patients (p = 0.016) and more diabetics (p = 0.041).

CONCLUSION

Systematic review sheds light on plausible risk factors on site of silicone oil migration. Majority of orbital cases are symptomatic and require intervention while retrolaminar cases are incidental and can be managed conservatively. Awareness of this complication can help guide clinicians predict which patients would likely need surgical intervention. Graphical abstract.

Unique Characteristics of Intravitreal Silicone Oil on Dual-Energy Computed Tomography

Silicone oil is used as an intravitreal injection to treat retinal detachment. This material can spread into the subarachnoid space, where it may be mistaken for acute hemorrhage on single-energy computed tomography. This report describes the appearance of intravitreal silicone oil on dual-energy computed tomography, emphasizing unique virtual monoenergetic imaging characteristics that allow for confident differentiation of silicone oil from hemorrhage as well as from other potential single-energy mimics, such as calcium and iodine.

Watch out for the special location of intraventricular silicone oil following an intraocular tamponade - a 10-year follow-up case report based on CT/MRI

Background

Intraventricular silicone oil is a relatively rare complication resulted from silicone oil tamponade to treat retinal detachment. It is occasionally reported in previous literature. To the best of our knowledge, the long-term longitudinal comparisons of silicone oil both in the brain and in the postoperative eyeball based on CT/MRI were lacking, and intraventricular silicone oil accumulation beside lesions has been reported rarely.

Case presentation

A 63-year-old male patient underwent an intraocular tamponade with silicone oil in June 2009. Eight CT examinations and 2 MRI examinations were acquired between 2011 and 2018.The changes of silicone oil in the brain in CT/MRI as below: Silicone oil initially migration to bilateral lateral ventricular anterior horn was found in November 2011, it was aslo found at right side of suprasellar cisterna, and there was no change in location 6 h later; Silicone oil at the anterior horn of right lateral ventricle disappeared but remained at left lateral ventricle and right side of suprasellar cisterna in July 2014, and there was no change in location in a short-term reexamination. It was found at the middle of left lateral ventricle (adjacent to the real cause) in march 2018, but disappeared 3 months later, while remained at anterior horn of left lateral ventricular and right side of suprasellar cisterna all the time. There was no change in location in the next 2 follow-up (September and October in 2018). The CT values of silicone oil distributed throughout the brain were dynamically changed with time.

Conclusion

It is important to recognize intraventricular silicone oil in a particular location.More important is to discover “the real murderer”, which is the main cause of symptoms in the vicinity of special location. Moreover, the migration of silicone oil between eyeball and brain may not be always in a single direction.

Intracranial migration of intraocular silicone oil following repetitive head trauma

Intraocular injection of silicone oil as a tamponade agent is a commonly used technique for the treatment of retinal detachment. An incompletely understood phenomenon which can occur after injection is the migration of silicone oil from the vitreous chamber to the intracranial space. Because the appearance of silicone oil can mimic hemorrhage or other pathologies on CT and MRI, careful comparison with prior studies is necessary to avoid unnecessary follow-up studies. We report a case of intracranial migration of intraocular silicone oil following repetitive head trauma.

Subretinal and Retrolaminar Migration of Intraocular Silicone Oil Detected on CT

BACKGROUND AND PURPOSE

Intraocular silicone oil injection has been used to treat complicated retinal detachments, and recently its retrolaminar and intracranial migration has been reported. The purpose of this study was to document the prevalence of posterior migration of intraocular silicone oil on head CT and describe the clinical and radiologic findings.

MATERIALS AND METHODS

This retrospective study included 57 patients with intraocular silicone oil injection who underwent unenhanced head CT between November 2008 and July 2018. All images were visually evaluated for subretinal and retrolaminar migration of intraocular silicone oil involving the anterior visual pathway (optic nerve, optic chiasm, and optic tract) and the ventricular system. Attenuation values of those structures were measured and compared with those of the contralateral or adjacent normal structures.

RESULTS

We detected subretinal and retrolaminar silicone oil migration in 7 of the 57 patients (12%), noting silicone oil at the optic nerve head (n = 2), retrolaminar optic nerve (n = 5), optic chiasm (n = 3), optic tract (n = 3), and in the lateral ventricles (n = 1). Attenuation values of the structures with silicone oil migration were significantly higher than those of the control regions (optic nerve head, 69.2 ± 12.4 vs 29.8 ± 10.2 HU, P < .001; retrolaminar optic nerve, 59.9 ± 11.6 vs 30.9 ± 8.6 HU, P < .001; optic chiasm, 74.2 ± 11.0 vs 25.6 ± 6.9 HU, P < .001; optic tract, 70.1 ± 4.7 vs 28.7 ± 7.2 HU, P < .001). No significant ophthalmic or neurologic complications were documented in the patients with silicone oil migration.

CONCLUSIONS

Subretinal and retrolaminar migration of intraocular silicone oil is common. Although there were no apparent complications associated with silicone oil migration, the radiologist and clinician should be aware of this phenomenon.

Optic Nerve Sheath Fenestration for Treatment of Retrolaminar Silicone Oil Migration

The authors report the case of a 75-year-old man with preexisting glaucoma and recurrent retinal detachment who underwent intraocular silicone oil placement OD resulting in subsequent retrolaminar silicone oil migration to the optic chiasm and vision loss OS. MRI showed silicone oil tracking posteriorly along the right optic nerve to the chiasm. He was placed on high-dose corticosteroids and underwent a successful optic nerve sheath fenestration with improvement of vision in the contralateral eye. Clinicians should be cognizant of the potential for translaminar posterior migration of intraocular silicone oil, as well as the utility of optic nerve sheath fenestration to decompress the anterior visual pathways and restore vision.