Published online May 28, 2015. doi: 10.4329/wjr.v7.i5.100
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
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.
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.