Woman with dysphagia (Full Version)

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chiroortho -> Woman with dysphagia (December 2, 2004 4:22:00 AM)

What do you see here?

[image]http://www.rad.washington.edu/quickcases/cases/Case08/LatCSpine.jpg[/image]



FLAOrthoPT -> Re: Woman with dysphagia (December 2, 2004 4:25:00 AM)

looks almost like natural anterior fused c-spine..or is that calcification in her esophagus or trachea? looks strange for sure-



chiroortho -> Re: Woman with dysphagia (December 2, 2004 4:32:00 AM)

What do you think? You're on the right track. Remember your anatomy.

Would you consider this to be degenerative in nature (notice the normal disc heights)?

I'll tell you what it's not: calcification within the esophagus or trachea. Good guess though.



tr6454 -> Re: Woman with dysphagia (December 2, 2004 6:22:00 AM)

Greg,

? diffuse idopathic skeletal hyperostosis (DISH)

Terry



chiroortho -> Re: Woman with dysphagia (December 2, 2004 7:12:00 AM)

Terry,

Exactly right! From the University of Washington Radiology Teaching File: [QUOTE]Diffuse idiopathic skeletal hyperostosis syndrome (DISH)

Findings
>Flowing ossification of the anterior longitudinal ligament, involving at least 4 adjacent disk spaces
>Lack of intervertebral disk space narrowing

Brief Discussion
DISH syndrome is an idiopathic disorder, and therefore, by definition, a diagnosis of exclusion. In general, one must exclude 3 other entities that can commonly present with fairly large "phytes" in the spine:

1. ankylosing spondylitis
2. degenerative nuclear disease
3. degenerative annular disease[/QUOTE]This is a perennial favorite on the Florida Board of Chiropractic Medicine examination.



jma -> Re: Woman with dysphagia (December 2, 2004 7:24:00 AM)

Wow!,
Would have never guessed this but the ossification was very clear. Definitely, one to remember if I ever see C-spine radiographs.

JMA



FLAOrthoPT -> Re: Woman with dysphagia (December 2, 2004 1:34:00 PM)

bizarre..yeah knew it looked fused anteriorly but never really saw that before..cool, for me, not for her



bonmar -> Re: Woman with dysphagia (December 2, 2004 5:05:00 PM)

Great pics and post but I am curious if dysphagia was this patients only symptom? Also, please clarify why DISH would cause dysphagia? Elevated hyoid?



chiroortho -> Re: Woman with dysphagia (December 2, 2004 5:14:00 PM)

encroachment upon the esophagus. That's why I said earlier to remember your anatomy. Now you'll look at the picture and go 'of course'.

Don't know her other symptoms, but since you asked, DISH is frequently asymptomatic in and of itself. It's essentially an autofusion, and is found incidentally, eg a patient comes in after an MVA, has some films and voila!



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