S2167 Rare Cause of Dysphagia Due to Thoracic Vertebral Osteophytes

Abstract

Introduction: Symptomatic degenerative changes of the spine affect atleast 75% of the population above 60 years of age. Anterior bridging osteophytes can develop in association with diffuse idiopathic skeletal hyperostosis. They are usually asymptomatic. However, in some cases, osteophytes can impinge on the anteriorly located esophagus thereby causing dysphagia. Case Description/Methods: A 68-year-old man with osteoarthritis and hypertension presented with intermittent episodes of dysphagia to solids for 3 months. Symptoms had not progressed over this time and he was able to tolerate liquids without any difficulty. He denied vomiting, loss of appetite, weight loss or night sweats. He denied history of tobacco use or any significant alcohol intake. Hemoglobin was 12.6 g/dL. He was initially evaluated by speech language pathology with a modified barium swallow (MBS) that did not identify oropharyngeal dysphagia. An upper endoscopy revealed extrinsic compression in the mid esophagus, but no evidence of luminal mass, ulceration or candidiasis. A barium esophagram showed indentation on the posterior wall of the esophagus. Computerized tomography (CT) chest imaging demonstrated large anterior osteophytes at thoracic vertebral level T2/T3 (Figure 1). Given the clinical presentation and workup, the patient’s dysphagia was attributed to the large anterior thoracic osteophytes. He was referred to an orthopedic surgeon and preferred conservative non-operative management with dietary modification. Discussion: We present here a case of dysphagia due to large thoracic vertebral osteophytes. Symptomatic osteophytes usually originate in the cervical spine. Thoracic osteophytes may not initially present with esophageal symptoms because the thoracic esophagus is a relatively mobile structure that can be displaced anteriorly or laterally without being compressed. Large osteophytes can cause dysphagia by obstruction and altered esophageal peristalsis. An osteophyte should be considered as the cause of obstruction and dysphagia when an esophagogram shows marked hypertrophic changes in the thoracic spine at that level. CT or magnetic resonance imaging (MRI) may be helpful for demonstrating a bony mass impinging on the esophagus and to exclude a vascular anomaly, neoplasm, or other possible lesions. Patients should be counseled on the importance of dietary modification, speech and swallow therapy, along with weight loss and physical therapy. Surgical removal of the osteophytes is considered for intractable symptoms.Figure 1.: Computerized tomography (CT) chest imaging in sagittal view demonstrated large anterior osteophytes at thoracic vertebral level T2/T3.