Figure 15.

A 67-year-old female presented with abdominal discomfort. She had a history of left infiltrative lobular carcinoma T1N0 status post-bilateral total mastectomies and left axillary dissection with bilateral dual implant reconstructions over 20 years ago. She subsequently underwent three separate implant revisions , most recently having replacement of her subpectoral silicone implants. Initial blood work, including CBC and a chemistry panel, showed normal liver function tests. (a) An abdominal ultrasound was initially performed which showed dense echogenic shadowing throughout the liver, suggestive of the “snowstorm” appearance of silicone. (b) Ultrasound of the spleen demonstrated similar dense echogenic shadowing diffusely. (c) Abdominal MRI with elastography was performed which showed normal liver stiffness and no suspicious abnormality. White line denotes the ROI drawn to measure mean liver stiffness. (d) DECT was performed due to suspicion of silicone deposition. Axial and coronal DECT of the abdomen shows silicone in the spleen and splenules, as noted by green color mapping (arrow). Not much silicone is seen in the liver. (e) Silicone sensitive MRI was performed. Coronal and sagittal sequences show hyperintense signal in spleen (arrow), compatible with silicone deposition. The liver (arrowhead) is minimally hyperintense without definitive findings of silicone deposition on MRI. DECT (f) and silicone sensitive MRI (g) sequences also show silicone in thickened right pectoralis muscle (blue arrow) and in normal sized right internal mammary lymph nodes (arrow). Muscle thickening was likely post-operative from prior implant revision. In this case, silicone was detected in the spleen on ultrasound, DECT, and MRI, while silicone in the liver was best detected on ultrasound. CBC, complete blood count; DECT, dual energy CT; ROI, region of interest.