title: Silver nitrate mimicking a foreign body in the pharyngeal mucosal space.
abstract: Silver nitrate is sometimes used as a means of chemical cauterization for control of minor bleeding and management of hypergranulation tissue following bedside head and neck procedures. There are only few reports available on the imaging appearance of silver nitrate and its potential to mimic a foreign body. We report a case of a patient presenting with dysphagia, odynophagia, and fever following dental work who had a peritonsillar incision and drainage for treatment of a deep neck space infection. During the procedure, silver nitrate was applied to halt the bleeding. Patient was subsequently transferred to another institution. Since the patient was not showing significant clinical improvement on antibiotic therapy, a computed tomography (CT) scan was performed demonstrating a hyperdense structure lodged in the pharyngeal mucosal space in the oropharynx and soft palate that was mistaken for a foreign body such as bone. Silver nitrate can have density similar to bone but does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT, lack of bone architecture, and proper documentation and communication of the use of silver nitrate to the consultant radiologist and medical personnel could help avoid misdiagnosis and potentially unnecessary surgical exploration.
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Devon
authors.initials: D
authors.lastname: Livingstone
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Yazeed
authors.initials: Y
authors.lastname: Alghonaim
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Jowett
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Eyal
authors.initials: E
authors.lastname: Sela
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Mlynarek
authors.affiliation: Devon Livingstone, Department of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada.
authors.forename: Reza
authors.initials: R
authors.lastname: Forghani
keywords: Bony foreign body; Computed tomography; Deep neck infections; Pharyngeal mucosal space; Silver nitrate; Soft tissues neck