Posterolateral Hip Pain caused by Silicone-Induced Foreign Body

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Posterolateral Hip Pain
Ultrasound of the left hip showing dense hypoechogenicty of the gluteus medius with loss of normal echotexture and hyperechoic appearance as well as several anechoic areas posteriorly.

Posterolateral hip pain caused by injectable silicone for soft tissue augmentation.

This article highlights the case of a 31-year-old female patient with a 5-year history of posterolateral hip pain. The patient was initially diagnosed with trochateric bursitis at an outside facility. Doctors treated the patient with an X-ray guided steroid injection to the trochanteric bursa at the time. However, this caused the pain to worsen. On presentation to the clinic, the patient described the pain as dull and scored it 4/10. She said the pain alleviated by rest, whereas aggravated by movement. In addition, she denied erythema and joint swelling.

The patient’s physical examination showed full-range movement of the left hip, normal gait and station. There were no signs of erythema, tenderness or swelling. However, the left lateral thigh was consistent with point tenderness. Laboratory studies including normal erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were unremarkable.

Bilateral hip X-ray did not reveal any abnormalities either.

Doctors further advised a musculoskeletal ultrasound of the left lateral and posterior hip which showed normal gluteus minimus. However, loss of normal echotexture and dense hypoechogenicty of the gluteus medius was evident. The ultrasound further showed hyperechoic appearance, posteriorly of several anechoic areas. Probe palpation was consistent with tenderness correlated to the hyperechoic areas over the gluteus medius. Findings of the right lateral hip were similar, however, less prominent. In addition, the findings showed that the gluteus medius was the most affected.

On further questioning, the patient revealed that she had undergone silicone injections in the past. Doctors advised magnetic resonance imagine (MRI) because the deeper tissue could be visualised due to artifacts. The imaging showed innumerable small low signal foci throughout the gluteus maximus, bilaterally overlying subcutaneous fat. The patient was diagnosed with posterolateral hip pain caused by a silicone-induced foreign body.

References

Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057356/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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