52-year-old woman notes an enlarging bulge in the lateral side



Doctor's Information

Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------


Case Section

Breast Imaging


Patient's Information

Gender : Female
Age : 52


Clinical Summary

52-year-old woman had implants for 7 years, presents with pain & an enlarging bulge in the lateral side of her right implant.


Imaging Findings

Right breast’s sub-pectoral implant demonstrates multiple wavy lines (linguine sign), associated with mass like lesion lateral to the edge of the implant at right axillary region, after contrast administration 3D reconstructed images reveals mass like enhancement within the fibroglandular tissue of right breast (fast wash-in & rising curve), also lobulated enhancing mass at axillary region ( slow wash-in & wash out curve). Note is made of the same signal intensity of the mass with silicone, also high signal intensity around it on fat suppressed T2w images consistent with severe inflammatory reaction.


Differential Diagnosis



Final Diagnosis

Intra & extra-capsular rupture of implant (silicone granuloma).


Discussion (Related Text)

The most dramatic and reliable MRI sign of capsular rupture is the demonstration of multiple curvilinear low signal lines that correspond to the collapsed elastomer shell (linguine sign). The collapsed ruptured shell and the free silicone are strange evidence for extracapsular rupture. Five appearances of extracapsular silicone have been described with MR: (I) cyst, (2) granuloma, (3) infiltration of fatty breast parenchyma, (4) infiltration of muscle, (5) globules in muscle. If the silicone forms a fluid collection, it will appear as a cystic mass that has the same high intensity on T2-weighted sequences as intracapsular silicone. If the silicone becomes infiltrated with scar (granuloma formation), then the intensity will vary depending upon the concentration of silicone within the granuloma. Less than 5 to 15% silicone concentration is probably not detectable with current MRI techniques. Irregular, lacy silicone infiltration of both breast tissue and muscle will be bright on T2-weighted sequences. Usually this pattern is due to previous silicone injection. Silicone muscle globules are similar in appearance to silicone cysts in the breast. Globules are a rarer presentation of silicone migration to muscle.



Practical MR Mammography, Uwe Fischer.
Signs in MR-mammography, Warner A. Kaiser.


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