DISH-Diffuse idiopathic skeletal hyperostosis a rare cause of dysphagia in ENT
18 April 2018 (online)
Diffuse idiopathic skeletal hyperostosis- DISH makes a rare clinical appearance in ENT and is a systemic, non-inflammatory skeletal disease which is characterized by ossification of the entheses and ligaments, better known as Morbus Forestier. This hyperostosis mostly appears in the thoracic spine fewer in the cervical spine. DISH occurs more frequently patients with diabetes mellitus typ II and fat metabolism disorder. A 85 year old man presented with severe dysphagia in a progressive process since two years. Within the two years the patient lost 20 kg. Pasty food could be better swallowed than solid food. Fluids has to be hold on in the mouth till he can swallow without aspiration. The past medical history showed diabetes mellitus typ II, arterial hypertension and thrombocytosis. A year ago a gastroscopy was already performed, and results were unremarkable. The patient underwent a fiberoptic endoscopic evaluation of swallowing (FEES). During the examination a big vertebral swell was shown compressing the Hypopharynx. The mucous membrane was inconspicuous. In addition a computed tomography of the neck was performed which showed a distinctive ventral cramped ossification of the cervical ligaments, resulting in a constriction of the pharyngeal lumen, which is characteristically for DISH. Because of the severe diagnostic findings the patient was send to the neurosurgical department. In summary, DISH may become more and more the cause of dysphagia due to its association with diabetes and obesity. This case report shows that clinicians should be aware of the cervical manifestation of DISH.