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.

Smoky Diagnosis: Importance of Patient History in Vaping Associated Lung Injury.

E-cigarette or vaping use associated lung injury (EVALI) recently became a common cause of respiratory illness. The pathophysiology of EVALI is relatively unknown, and thus the disease remains a diagnosis of exclusion. There are no specific tests or markers that exist, although there is some belief that Vitamin E acetate is strongly linked to the increase in EVALI cases. Immediate recognition of EVALI patients is critical in order to reducing severe outcomes. For these cases, the importance of a complete patient interview is emphasized and necessary for diagnosis. We present a case of a young patient presenting with hypoxic respiratory failure due to EVALI, in which diagnosis was delayed due to incomplete patient history.