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