Diffuse Idiopathic Skeletal Hyperostosis induced Oropharyngeal Dysphagia
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General Internal Medicine, Geisinger Medical Center Danville, PA, USA; 2General Internal Medicine, Guthrie Robert Packer Hospital Sayre, PA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-05915-x © Society of General Internal Medicine 2020
80-year-old man with a history of hypertension A npresented with shortness of breath due to a COPD exacerbation. He also had three weeks of solid meal dysphagia. A video fluoroscopic swallow study showed pharyngeal stenosis. Laryngoscopy demonstrated fullness in the posterior pharyngeal wall. Lateral cervical x-ray (Fig. 1) and cervical spine CT (Fig. 2) showed large cervical osteophyte formation consistent with diffuse idiopathic skeletal hyperostosis (DISH). He underwent cervical spine osteophyte resection, and his oropharyngeal dysphagia resolved. DISH is a non-inflammatory disease characterized by ossification of the tendon, ligament, or joint capsule Figure 2 CT axial view of the cervical spine showing extensive bulky osteophyte formation consistent with DISH.
insertion, usually involving the spine.1 It mostly involves the thoracic spine but can also affect the cervical and lumbar regions. DISH involving the cervical spine is usually asymptomatic but sometimes presents with pain, foreign body sensation, stiffness, and rarely, dysphagia.2, 3 The diagnosis of DISH is radiographic. It is better visualized with CT scan than with plain film radiographs. Conservative management includes nonsteroidal anti-inflammatory medications, diet modification, corticosteroids, muscle relaxants, and orthotics.4, 5 Surgery (osteophytectomy) is reserved for patients suffering from progressive dysphagia interfering with adequate nutrition, 6 airway obstruction, and neurologic compromise.7 Figure 1 Lateral cervical x-ray showing multilevel cervicothoracic spine bulky bridging osteophytes traversing the anterior cervical intervertebral discs that have some degree of mass effect on overlying hypopharynx/esophagus.
Corresponding Author: Rajesh Essrani, MD; General Internal Medicine, Geisinger Medical Center Danville, PA, USA (e-mail: Raj1_ [email protected]).
Compliance with Ethical Standards: Received July 10, 2019 Accepted May 5, 2020
No IRB approval needed.
Essrani et al.: Oropharyngeal dysphagia Conflict of Interest: The authors declare that they do not have a conflict of interest.
4. 5.
Consent: Consent was obtained from patient. 6.
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Miyazawa N, Akiyama I. Ossification of the ligamentum flavum of the cervical spine. J Neurosurg Sci 2007;2013:139–44 Utsinger PD. Diffuse idiopathic skeletal hyperostosis. Clin Rheum Dis 1985; 11:325. Bakker JT, Kuperus JS, Kuijf HJ, et al. Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine. PLoS One 2017; 12:e0188414.
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JGIM
Umerah BC, Mukherjee BK, Ibekwe O. Cervical spondylosis and dysphagia. J Laryngol Otol. 1981;95:1179–1183. Deutch EC, Schild JA, Mafee MF. Dysphagia and Forestier's disease. Arch Otolaryngol. 1985;111:400–402. Castellano DM, Sinacori JT, Karakla DW. Stridor and dys
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