Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2015; 7(5): 100-103
Published online May 28, 2015. doi: 10.4329/wjr.v7.i5.100
Silver nitrate mimicking a foreign body in the pharyngeal mucosal space
Devon Livingstone, Yazeed Alghonaim, Nathan Jowett, Eyal Sela, Alex Mlynarek, Reza Forghani
Devon Livingstone, Department of Otolaryngology–Head and Neck Surgery, University of Calgary, Calgary, Alberta T2N 2T9, Canada
Yazeed Alghonaim, Nathan Jowett, Eyal Sela, Alex Mlynarek, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec H3A 1A1, Canada
Reza Forghani, Department of Radiology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, Quebec H3T 1E2, Canada
Author contributions: All authors contributed to this manuscript.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of the Jewish General Hospital and informed consent was waived.
Informed consent: The study was reviewed and approved by the Institutional Review Board of the Jewish General Hospital and informed consent was waived.
Conflict-of-interest: The authors do not have any conflict of interest to declare pertaining to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Reza Forghani, MD, PhD, Associate Chief, Assistant Professor of Radiology, Department of Radiology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Room C-210.2, 3755 Cote Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada. rforghani@jgh.mcgill.ca
Telephone: +1-514-3408222
Received: December 24, 2014
Peer-review started: December 26, 2014
First decision: January 8, 2015
Revised: February 9, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: May 28, 2015
Processing time: 155 Days and 23.4 Hours
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.

Keywords: Silver nitrate; Computed tomography; Bony foreign body; Soft tissues neck; Deep neck infections; Pharyngeal mucosal space

Core tip: This manuscript describes the imaging features of silver nitrate on computed tomography (CT). Silver nitrate is sometimes used as a means of chemical cauterization during bedside head and neck procedures. Silver nitrate has high attenuation on CT and has the potential to mimic a radio-opaque foreign body such as bone. However, it does not have the normal architecture of bone with cortex and marrow on CT. Familiarity with the appearance of silver nitrate on CT and proper communication of its use to the consultant radiologist could help avoid misinterpretation as a foreign body on imaging.