CT Signs of Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Diffuse idiopathic skeletal hyperostosis (DISH) is considered an underdiagnosed and mostly asymptomatic non-inflammatory osteoarthritis. The etiology of DISH remains unknown with no validated diagnostic criteria. This condition is solely diagnosed radiologically. Symptoms vary from asymptomatic to disabling neurological conditions. In this paper we report a case of progressive dysphagia and neck pain due to DISH of the cervical spine in a 73-year-old man, imaging studies was used to support the diagnosis.In this paper, we also discuss the clinical features and differential diagnosis and review of literature. CT Signs of Diffuse Idiopathic Skeletal Hyperostosis (DISH) ARC Journal of Radiology and Medical Imaging Page | 2 3. DIFFERENTIAL DIAGNOSIS A wide spectrum of medical condition overlaps with DISH. Ankylosing spondylitis (AS) sprung up a major concern differentiating it from DISH both clinically and radiologically; both entities cause a certain degree of spinal deformability and postural abnormality and both share the involvement of axial skeleton and peripheral enthesis. Clinically, AS present at an earlier stage of life, mainly consist of inflammatory spinal pain and stiffness leading to a decreased range of spinal movement. Advanced AS presents characteristically with postural abnormality, notably Bechterew stoop. On the other hand, DISH affect primarily middle-aged person and it is often asymptomatic in presentation or with mild spinal pain. Radiologically, AS typically presents with bilateral symmetrical erosivesacroiliitis, Romanus lesion and squaring of the vertebral bodies leading to bamboo spine,which consists of bilateral marginal paravertebral symmetrical syndosmphytes that radiologically differ from osteophyte by the fact that is vertically oriented rather than horizontal such as the osteophyte. Degenerative osteoarthritis (OA) is considered one of the most common chronic conditions affecting the joints, and one of the most common causes of osteophyte formation in the cervical spine. OA is, however, readily differentiated from DISH giving its distinguished radiological appearances such as disk space narrowing, sclerosis. These patterns are less frequently seen in DISH. Other conditions that should be taken into consideration are Psoriatic arthritis, Reactive arthritis and retinoid arthropathy.