RESUMO
Local adverse reactions to breast implants and systemic reactions, mostly autoinflammatory, are numerously described in the literature. A patient presented at our institution with severe neurologic symptoms, including confusion and phasic troubles due to severe hyponatremia as part of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Common etiologies for SIADH, primarily malignancy and central nervous system disturbances, have been ruled out by imaging. On the computed tomography scan of the thorax and abdomen, several masses were found in the pectoral region, inferior to the sternum and in the left axilla that were biopsied and verified as silicone. While evaluating the patient's medical history, the patient remembered having undergone breast augmentation with silicone implants several decades ago. The only explanation left for the persisting SIADH was her ruptured silicone implants, causing an inflammatory systemic reaction. Literature was searched, and one abstract was found, in which a woman presenting with SIADH was treated successfully after removal of her silicone breast implants. We offered the same treatment to our patient, and siliconomas were removed through a bilateral inframammary approach as well as axillary on the left. There were no complications encountered. Postoperatively, the patient's hyponatremia improved and normalized 1 month later even without hydric restriction. This potential form of etiology and treatment of SIADH is a novelty in the medical literature. Surgical removal of dispersed silicone is presumed to be the cure for this syndrome. It represents a diagnosis of exclusion after more life-threatening causes, such as central nervous system disturbances and malignancies, have been ruled out.
RESUMO
Available since the 1960s, the use of inferior vena cava filter has now become an alternative therapeutic approach in the management of venous thromboembolism in case of a contraindication to or a complication of anticoagulation. Their effectiveness in protecting against pulmonary embolism seems obvious in patients in whom anticoagulant treatment cannot be administred, but the literature is mainly based on two small size randomized controlled trials. The most used filters are "retrievable" filters, which can be removed after a certain time or left in place permanently. During long-term use, a significant rate of deep vein thrombosis was observed, when using permanent filters. This complication seems to disappear when "retrievable" filters are removed within 3 months of the implantation.
