Transient Hyperattenuating Oral Pseudolesion Mimicking Sialolithiasis Incidentally Detected on Chest Computed Tomography

Objective:Diagnostic challenge Background:Edible intraoral foreign bodies (IOFBs) such as hard candies and chewing gum are an important diagnostic pitfall on computed tomography (CT) because their attenuation often overlaps that of calcified pathology, including sialoliths.Reliance on density alone can prompt unnecessary imaging and patient anxiety.Recognition of typical locations, assessment of ductal anatomy and secondary signs, and short-interval reversibility after oral cavity clearance are key to avoiding misdiagnosis. Case Report:A previously healthy 35-year-old woman presented with a 3-day history of throat discomfort and dry cough.Non-contrast chest CT performed for cough evaluation incidentally depicted a well-circumscribed hyperattenuating focus adjacent to the right sublingual gland at the superior edge of the field of view (maximum diameter ~10 mm; mean attenuation ~400 Hounsfield units).Because the acquisition only partially covered the neck, ductal continuity with Wharton's duct, ductal dilation, and perilesional inflammation could not be assessed with confidence.The initial differential diagnosis included a distal Wharton's duct sialolith.Immediate intraoral examination revealed no visible abnormalities or sialolith.Seven days later, a dedicated non-contrast neck CT obtained under identical parameters demonstrated complete resolution of the hyperattenuating focus after explicit instruction to remove all intraoral items.On further questioning, the patient recalled having a cough lozenge in her mouth during the initial scan.Her symptoms resolved spontaneously, and no salivarygland-related concerns were reported thereafter. Conclusions:Routine pre-scan oral cavity clearance, structured evaluation of ductal continuity/dilation with clinical correlation, and limited repeat scanning when uncertainty persists are pragmatic safeguards that help prevent misdiagnosis and avoid unnecessary testing.