Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.