An unusual cause of dysphagia

Abstract

A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine (Fig. 1) revealed diffuse ossification of the anterior longitudinal ligament (straight line, Fig. 1). This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level (dashed line, Fig. 1) and there was severe narrowing of the airway (Fig. 1, arrows). He was diagnosed as Diffuse Idiopathic Skeletal Hyperostosis (DISH) or Forestier's disease, which is characterized by ossification of longitudinal ligaments (esp. anterior longitudinal ligament) (Fig. 2, arrows) along with sparing of sacroiliac joints (Fig. 3, arrows). It usually affects males aged greater than 50 years and is usually an incidental radiological finding and only symptomatic lesions need specific treatment. This patient was advised diet modification and surgical removal of the ossified mass if the dysphagia persisted. The most common differential of the DISH is Ankylosing Spondylitis (AS). These two entities can be differentiated on the basis of age at presentation and the involvement of a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x