Diffuse idiopathic skeletal hyperostosis (DISH)
65 year old female
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AP radiograph of the pelvis reveals extensive fluffy or "whiskering" enthesopathy of the iliac crests (red arrows), ischial tuberosities (yellow arrows), and the trochanters (black arrows). Note is also made of ossification of the iliolumbar ligament (blue arrow). Importantly, both sacroiliac joints appear normal. These findings are in keeping with diffuse idiopathic skeletal hyperostosis (DISH).
Diffuse Idiopathic skeletal hyperostosis (DISH) is a bone-forming diathesis primarily affecting the spine, with ossification of tendons and ligaments. Most of us are familiar with the spinal findings; however there are extraspinal manifestations as well such as hyperostosis at ligament attachments in the pelvis, calcaneus, tarsal bones, ulnar olecranon and patella. Usually these are incidental findings without significant morbidity.
- 1. Mader R, Sarzi-Puttini P, Atzeni F et-al. Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. Rheumatology (Oxford). 2009;48 (12): 1478-81. Rheumatology (Oxford) (full text) - doi:10.1093/rheumatology/kep308 - Pubmed citation
- 2. Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology. 1975;115 (3): 513-24. Radiology (citation) - doi:10.1148/15.3.513 - Pubmed citation