Article

Silicone pericarditis1

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Abstract

A 62-year-old white man was referred to the Cleveland Clinic for evaluation of dyspnea and chest pain. He had moderate aortic insufficiency and severe three-vessel coronary artery atherosclerosis. Some years before, epicardial pacemaker leads had been inserted, which were subsequently abandoned. At surgery for replacement of the aortic valve, and bypass grafts to the affected coronary arteries, an exuberant polypoid villonodular pericarditis was encountered. Frozen sections revealed a severe foreign body giant cell reaction. Light microscopy examination confirmed the foreign body reaction and revealed abundant foreign material in the pericardium. This was identified as silicone via electron microscopy coupled with energy dispersive analysis of emitted x-rays (EDAX). Silicone had inadvertently been introduced into the pericardium during insertion of epicardial pacemaker leads. The following report illustrates both the severity of the tissue reaction to silicone compounds introduced into body cavities, and the utility of EDAX in the identification of foreign material.


 

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