Diffuse idiopathic skeletal hyperostosis (DISH)

Case contributed by Dr Amr Farouk

Presentation

80 years old female patient presenting with neck pain.

Patient Data

Age: 80 years old
Gender: Female

Cervical vertebral bodies flowing ossification is noted along the anterior aspect of the cervical vertebrae namely the anterior longitudinal ligament extending from C2 down to C7 vertebral body with interdigitating extensions of ossification into C3/4 and C5/6 discs.Decreased bright T2 signal of rest of the cervical discs.The atlanto-axial joint articulation shows calcified related ligaments  eliciting iso to low signal on T1 WI & intermediate signal on T2 WIs.It is seen abutting  the anterior subarachnoid space yet not touching the cord.

C3/4 central posterior disc protrusion is seen encroaching on the anterior subarachnoid space, yet not indenting the cord.

C5/6 posterior & more prominent left posterolateral disc protrusion/osteophyte complex is seen effacing the anterior subarachnoid space, flattening the cord and encroaching on nerve roots pathways more on the left side.

C6/7 broad based posterior disc protrusion is seen encroaching on the anterior subarachnoid space, flattening the cord and encroaching on nerve roots pathways.

The cervical cord shows homogeneous signal intensity with no focal intra-medullary lesions. Normal cervico-medullary junction.

Axial T1 WIs showed a left upper lobe pulmonary cavitary lesion is seen at the apicoposterior segment measuring 3.6X3 cm with adjacent reticulations & smaller posteriorly located nodules.Right upper lobe apical segment showed few pulmonary nodules with reticulations as well.(likely old granulomatous infection).

Case Discussion

Cervical vertebral bodies flowing ossification is noted along the anterior aspect of the cervical vertebrae namely the anterior longitudinal ligament extending from C2 down to C7 vertebral body with interdigitating extensions of ossification into C3/4 and C5/6 discs. MR picture of diffuse idiopathic skeletal hyperostosis (DISH).

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Case Information

rID: 49771
Case created: 3rd Dec 2016
Last edited: 3rd Dec 2016
Tag: dish
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