key: cord-0944561-stg89gm4
authors: Sikka, Kapil; Sakthivel, Pirabu; Chandran, Aswin; Mohammed, Adil
title: An Unusual Cause of Dysphagia
date: 2020-09-02
journal: Dysphagia
DOI: 10.1007/s00455-020-10186-z
sha: 666187619a2dd4681ea88a4201b6bcfff2378758
doc_id: 944561
cord_uid: stg89gm4

nan

Lateral cervical X-ray showed large coarse floating osteophytes compressing the esophageal lumen and narrowing of airway on flexing neck (Fig. 2) . A CT scan of neck and chest revealed multiple anterior osteophytes with preservation of intervertebral disc space of cervical and thoracic vertebrae with extrinsic compression of cervical esophagus suggestive of diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease (Fig. 3 ).

Forestier disease or DISH, a rheumatological condition of unknown etiology is characterized by continuous ossification of ligaments and entheses, especially in the axial skeleton but also in peripheral joints [1] . Forestier first described this entity in 1950 as a case of senile ankylosing hyperostosis of the spine, and it was renamed as DISH by Resnick et al. in 1975 [2, 3] . Radiological diagnostic criteria's include continuous ossification of the anterior longitudinal ligament involving at least four contiguous vertebra, lack of intervertebral ankyloses or fusion, and preservation of intervertebral disc height [3] . Despite the impressive structural changes, patients with DISH may be largely asymptomatic. Cervical involvement with large anterior osteophytes can present with dysphagia, dyspnea, or dysphonia as in our case [1] . Treatment is mainly conservative with diet modification, analgesic and anti-inflammatory medication, and muscle relaxants [4] . Surgery is indicated for patients with severe symptoms such as progressive dysphagia, respiratory distress, and in whom the conservative approach has failed [1, 5] . Our patient was reassured about the condition and also because of the COVID-19 pandemic surgery was not advised. In six-month follow-up, the patient remained free of symptom progression. 

Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next

Senile ankylosing hyperostosis of the spine

Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH)

Giant anterior cervical osteophyte leading to Dysphagia

Surgical outcomes of dysphagia provoked by diffuse idiopathic skeletal hyperostosis in the cervical spine