Diffuse idiopathic skeletal hyperostosis (DISH): an unusual cause of airway obstruction

Description

Acute airway obstruction is a common ENT emergency with a wide range of aetiologies. The most common causes are infection, malignancy and foreign bodies, but more unusual causes should be considered.1

A 77-year old gentleman presented to the emergency department with worsening difficulty in breathing for 3 months since undergoing spinal surgery for multilevel cervical myelopathy. He of stertor, cough, dysphagia and intermittent apnoea. He was otherwise systemically well with no clinical signs of sepsis. Flexible nasendoscopy revealed a large posterior pharyngeal wall mass obscuring the glottis (figure 1).

Figure 1

Flexible nasendoscopy demonstrating a large posterior pharyngeal mass protruding into the airway resulting in narrowing of the glottic inlet as well as supraglottic oedema (Os, osteophyte compressing the posterior pharyngeal wall; Ep, epiglottis; *vocal fold demonstrating glottic oedema).

CT of the neck revealed a large confluence of osteophyte...

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