Skeletal Hyperostosis as a Cause of Aspiration
An otherwise healthy 78-year-old man was admitted for the surgical treatment of a right-sided pleural empyema in an advanced stage. His wife related that he had been suffering for months from unclear speech, a stubborn cough, and food and drink “going down the wrong pipe.” The empyema was treated by decortication via thoracotomy, and a PEG tube was placed for nutrition. A cervical spine x-ray revealed, as the probable cause of repeated aspiration and pleural empyema, diffuse idiopathic skeletal hyperostosis (DISH) of the cervical spine, also known as Forestier’s disease. DISH is a non-inflammatory skeletal disease of the spine, of unknown cause, that arises at the bony insertions of tendons, ligaments, and joint capsules. Pleural empyema secondary to aspiration is certainly a rare initial presentation of DISH; patients more commonly come to medical attention because of dysphagia or, occasionally, sleep apnea syndrome. In this patient‘s further course, the osteophytic changes were resected through an anterior cervical approach, whereupon his dysphagia and dysarthria markedly improved.
Dr. med. Christof Keller, Dr. med. Jürgen Knuth, Abteilung für Allgemein-, Viszeral-, Thorax-, Gefäß- und Kinderchirurgie, Klinikum Kempten-Oberallgäu; firstname.lastname@example.org
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as: Keller C, Knuth J: Skeletal hyperostosis as a cause of aspiration. Dtsch Arztebl Int 2017; 114: 0711. DOI: 10.3238/arztebl.2017.0711