Question: A 33 year old male is referred to you for epistaxis and septal perforation by a rheumatologist.  Examination reveals a large, ulcerated septal perforation.  The patient has no history of nasal trauma, unusual infections, or prior surgery.  Laboratory studies were obtained by rheumatology that demonstrated positive c-ANCA serology.  The patient has no findings suggestive of kidney or lung disease.  What substance can result in the findings above?

[Answer will be posted with next week's new question]

Answer to last week's question, "High Pressure Situation" (May 21, 2018)

External laryngocele.  Presence of air in the cyst (as opposed to fluid).