Diffuse idiopathic skeletal hyperostosis (DISH)

Case contributed by Dr Arvind Aggarwal

Presentation

Neck pain or stiffness with dysphagia

Patient Data

Age: 65
Gender: Male
X-ray

Forestier's Disease (DISH).

DISH ( Diffuse idiopathic skeletal hyperostosis )

Flowing ossification of more than 4 contiguous vertebrae with preservation of disk spaces and facetal joints. ( Ossification may thicken as disease becomes more chronic )

Case Discussion

DISH (Diffuse idiopathic skeletal hyperostosis)

It is a non-inflammatory spondyloarthropathy. The radiological imaging findings are characteristic, although have to be differentiated from other spondyloarthropathies. 

Florid flowing ossifications involving four or more contiguous vertebrae on anterior aspects, preservation of the disc spaces and the facetal joints helps to identify the disease radiologically. Classically, advanced disease may have "melted candle wax" appearance along the spine on radiographic studies.

Extra-spinal features includes enthesopathy at various sites (iliac crest, ischial tuberosities, and greater trochanters)

Differential diagnosis: 

  1. Ankylosing spondylitis
  2. Degenerative disease
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Case information

rID: 28365
Case created: 23rd Mar 2014
Last edited: 2nd May 2017
Inclusion in quiz mode: Included

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