Diffuse idiopathic skeletal hyperostosis causing obstructing laryngeal edema

Abstract

Diffuse idiopathic skeletal hyperostosis (DISH), or ankylosing hyperostosis (“Forestier’s disease”), is an ossifying diathesis of unknown etiology. Diagnosis is primarily radiologic: osseous bridging of at least four contiguous vertebral bodies, a radiolucent line between the deposited bone and the anterior vertebral surface, large osteophytes and preservation of disk height especially in the cervical and lumbar spine. Although DISH is found in 6–12% of autopsy cases, clinical features are rare and consist primarily of swallowing disorders. A case of DISH is reported in which excessively enlarged cervical osteophytes led to edema of the laryngeal inlet and consequent severe dyspnea, necessitating emergency tracheotomy. Surgical excision of the osteophytic masses resulted in relief of symptoms. Symptomatology, radiographic features and individual treatments are discussed, with the latter dependent on clinical symptoms.