IS case 476: Diffuse idiopathic skeletal hyperostosis

Narasimhachar Prativadi, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 63-year-old male with chronic back pain for 15 years.

Findings

Vertical ossification along the anterior margin of the vertebral bodies, most prominent at the upper thoracic spine. Bulky ossification along the anter

Discussion

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterior aspect of the vertebral bodies flowing across the disc spaces. In addition, it is associated with osteophytosis, ligament ossification, and hyperostosis at the tendon and ligament attachments to bone. In this condition the intervertebral disc spaces are usually well preserved. The most common site of DISH is the thoracic spine. The etiology of DISH is unknown. The signs and symptoms are mild in comparison to their radiographic appearance. There is usually no sacroiliitis or facet ankylosis. In this era of financial constraints, DISH is an important diagnosis to make because millions of dollars per year are awarded to federal employees upon retirement for degenerative changes acquired during their employment, when in fact they have DISH and have been misdiagnosed.

References

  1. Greenspan A. Orthopedic Imaging: A Practical Approach, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2004.
  2. Brant WE, Helms CA, eds. Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
  3. Weissleder R, Wittenberg J, Harisinghani MG, et al. Primer of Diagnostic Imaging, 4th ed. Philadelphia: Mosby Elsevier, 2007.

4 images