Diffuse skeletal hyperostosis (DISH)
Overview
DISH is a developmental disorder, meaning one isn't born with this but developed it at some time in their life. Usually, this is found incidentally on x-rays done for people with spine pain or even chest x-rays. DISH usually shows up in people in their 40s or 50s. It is thought of as a fibrosing (sclerosing, scarring) disease but isn't often associated with other fibrosing diseases such as IgG4 related disease or retroperitoneal fibrosis. It can cause pain but usually no more than discomfort and is more problem of reduced mobility. Patients with DISH can adopt a kyphotic posture.
Kyphosis = bending of the spine forward or anteriorly.
Imaging
From Uptodate
From Wikipedia
Differential Diagnosis
Ankylosing spondylitis
Ankylosing spondylitis shares some characteristics with DISH, such as a preponderance in males and an association with ligamentous ossification and syndesmophytes. In ankylosing spondylitis, however, the bony bridges are slender, vertical bony bridges that involve the outer margin of the annulus fibrosis and do not involve the anterior longitudinal ligament. In addition, erosions and bony ankylosis of the sacroiliac and apophyseal joints are not seen in DISH, although such changes can occur in patients with ankylosing spondylitis. Another feature that may be seen on plain radiographs in patients with DISH, but not those with ankylosing spondylitis, is the finding of bony excrescences adjacent to peripheral joints such as the knee or elbow. In one small study of 10 patients with DISH who had available magnetic resonance imaging (MRI) studies of the spine, bone marrow edema was identified in the anterior/posterior vertebral corners in five patients, and fat deposition in these corners was noted in eight patients, indicating that these findings are not specific for ankylosing spondylitis and suggesting that there may be overlapping pathogenetic mechanisms for new bone formation in these two disorders. [1]
Syndesmophytes/osteophytes Ankylosing spondyli
