Diagnosis and Management of Rare Siliconomas in an HIV Patient

Siliconomas are rare conditions stemming from uses of silicone injections for soft tissue augmentation, most commonly in the breast and buttocks areas. Siliconomas are known to present with suspicious morphology that mimics cases of embolism or systemic metastasis as the silicone travels through blood and lymphatics. We present the case of a 45-year-old HIV-positive male who presented with siliconomas in the breast region, chest heaviness, shortness of breath, dyspnea, and a physical exam showing gynecomastia. The patient denied any surgeries or injections around his chest. Further imaging showed abnormal fat deposition in the chest and possible metastatic lymphadenopathy to axillary, supraclavicular, and mammillary lymph nodes. Although the complications arising from silicone injections are well documented, the pathogenesis remains unknown, leaving a narrow range of therapeutic options. Despite these shortcomings, diagnostic imaging tools have shown to be vital in the diagnosis and localization of suspected siliconomas.