Ruptured silicone breast implant: a misleading chest X-ray.

The diagnosis of a ruptured breast implant can cause considerable confusion. We report a case of a ruptured breast prosthesis mimicking a primary lung tumour, to illustrate one of the diagnostic pitfalls that can occur in patients with silicone implants. CASE REPORT A 55 year old female was referred for investigation and possible surgery of a thyroid swelling. She had smoked 30 cigarettes per day for many years. Past medical history consisted of insertion of bilateral silicone breast implants 10 years previously. Clinical examination suggested a multinodular goitre and identified slight thickening superior to the left breast implant. Investigations revealed normal blood tests, and a multinodular goitre was confirmed on ultrasound scan. Routine chest X-ray (Fig. 1) identified an opacity in the left upper lobe showing features suggestive of a primary lung tumour. However, a lateral view failed to detect an abnormality in the thoracic cavity. CT scanning, performed with a view to percutaneous biopsy, revealed that the "lung tumour" was in fact related to the silicone implant (Fig. 2). Subsequent surgery confirmed rupture of the left breast prosthesis. DISCUSSION Routine chest radiographs may occasionally suggest the presence of a lung tumour which is found to be absent on subsequent investigations. Such pseudo-tumours can occur with skin lesions, subpleural silicotic nodules,' diaphragmatic hernia 2or ECG leads 3. Identification is important to prevent unnecessary intervention. There has recently been debate in the medical4 and lay press regarding potential complications of augmentation mammoplasty with silicone gel breast implants. Previous radiographic reports have been concerned with the detection Belfast City Hospital, Belfast BT9 7AB.