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Clinical Images  |   February 2017
Diffuse Idiopathic Skeletal Hyperostosis
Author Notes
  • From the Department of Internal Medicine at the McLaren Macomb Hospital in Mount Clemens, Michigan. Dr Saffo is a third-year resident. 
  •  *Address correspondence to Zaid Saffo, DO, 1000 Harrington Blvd, Mount Clemens, MI 48043-2920. E-mail: zaidsaffo@gmail.com
     
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images / Arthritis
Clinical Images   |   February 2017
Diffuse Idiopathic Skeletal Hyperostosis
The Journal of the American Osteopathic Association, February 2017, Vol. 117, 138. doi:10.7556/jaoa.2017.026
The Journal of the American Osteopathic Association, February 2017, Vol. 117, 138. doi:10.7556/jaoa.2017.026

Keywords: diffuse idiopathic skeletal hyperostosis, dysphagia, hyperostosis

A 74-year-old man with a history of diabetes mellitus and hypertension was found unresponsive in his home. The patient arrived at the emergency department after having cardiac arrest in the ambulance. He was admitted to the intensive care unit and ventilation was discontinued on hospital day 2. A positional stridor, hypoxia, and dysphagia were noticed after extubation. A computed tomographic image of the cervical spine showed anterior hyperostosis that was most prominent at C6-7 (image A, circle), which caused marked extrinsic compression of the esophagus and posterior trachea (image A and image B, arrows). An osteophyte excision was performed on day 10. The patient was able to maintain his own airway; however, dysphagia persisted and a percutaneous endoscopic gastrostomy tube was placed on day 15. On day 20, the patient was discharged to inpatient rehabilitation. Two months later, the tube was removed. 
Diffuse idiopathic skeletal hyperostosis (DISH) is a rheumatologic disorder, with primary clinical features being rigidity of the spine and advanced age.1 In severe cases, DISH can cause dysphagia and stridor.2 Classification criteria for identifying DISH include calcification and ossification along the anterolateral aspect of at least 4 contiguous vertebrae, preservation of the spaces between the intervertebral disks, and absence of facet joint ankylosis or sacroiliac joint erosion.3 Treatment depends on the symptoms. 
References
Forestier J, Rotes-Querol J. Senile ankylosing hyperostosis of the spine. Ann Rheum Dis. 1950;9(4):321-330. [CrossRef] [PubMed]
Castellano DM, Sinacori JT, Karakla DW. Stridor and dysphagia in diffuse idiopathic skeletal hyperostosis (DISH). Laryngoscope. 2006;116(2):341-344. doi:10.1097/01.mlg.0000197936.48414.fa [CrossRef] [PubMed]
Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559-568. doi:10.1148/119.3.559 [CrossRef] [PubMed]