Diffuse idiopathic skeletal hyperostosis (DISH) is a well-recognized cause of dysphagia1; we describe a case of an esophageal compression by a DISH cervical osteophyte.
A 62-year-old man came to our rheumatology clinic with an 8-year history of progressive spinal stiffness and a 4-year history of worsening dysphagia for solid foods. At admission, he showed a conspicuous limitation of spinal mobility, with neck motion substantially suppressed. A reduced chest expansion was evident. Shoulders and hips were also slightly limited. Thus he showed the typical postural abnormalities of ankylosing spondylitis (AS). The severe dysphagia allowed him to swallow only liquids.
Radiographs of the cervical, dorsal, and lumbar spine showed bony proliferations typical of DISH. In particular, the lateral view of the cervical spine revealed bulky “flowing mantles” of ossification in the anterior longitudinal ligament extending from the second to the seventh vertebra (Figure 1A)2. The DISH had clinically mimed AS, as we have previously described3. A barium swallow procedure confirmed the external pressure on the esophagus by a “monstrous” bony proliferation, with only a threadlike lumen remaining (Figure 1B).
DISH is a well-recognized cause of dysphagia1, but we had never observed a similarly impressive esophageal compression.
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