DX: Diffuse Idiopatic Skeletal Hyperostosis (DISH)

Ok thanks again for visiting my blog..you can also comment on my Facebook or Twitter account if it's too tricky to suscribe here..anyways, here is the conclusion of another musculoskeletal case that's quite interesting due to the fact that it's not commonly diagnosed, not because of rareness but for misleading findings often commited.

Here are the images once again: (click to enlarge)

Yellow arrows depict three findings: 1) Osteophyte formation ; 2) Endplate vertebral sclerosis; 3) Normal intervertebral space. May I add another one important: calcification of anterior longitudinal ligament.
Red arrow shows calcification of the nuchal ligament.

These findings are almost always diagnosed as osteodegenerative changes aso known as Degenarite Joint Disease (DJD). But there are main features that onse has to consider in order to diagnose DJD.

Brant & Helms great book "Fundamentals of Diagnostic Radiology" define DJD when encounter 3 aspects: 1) Osteophyte, 2) Bone sclerosis, and 3) NARROWING of joint space..if one of these are missing then other differentials need consideration.

The other features of this case are calcification of soft tissue (nuchal ligament and anterior longitudinal ligament [ALL]). In younger patients, we find calcification of ALL in ankylosing spondylitis but in older population as in this case, we refer to it as DISH.

Classic hallmark of DISH include:

• Flowing calcifications and ossifications along the anterolateral aspect of at least 4 contiguous vertebral bodies, with or without osteophytes.
• Preservation of disk height in the involved areas and an absence of excessive disk disease.
• Absence of bony ankylosis of facet joints and absence of sacroiliac erosion, sclerosis, or bony fusion, although narrowing and sclerosis of facet joints are acceptable.

Here's a picture from Brant & Helms book showing a case of DISH. (picture is property of authors and is shown for educational purposes).


Check this link to more detailed information
http://emedicine.medscape.com/article/388973-overview#a19




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