Case of the Day(sm)

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Neck pain

Our appreciation is extended to Dr. Mark Dalesandro,
Indiana University Department of Radiology,
for contributing this case.

History: Neck pain

Click these images to enlarge them.

Which choice best characterizes the salient finding(s)?

Residua of prior surgery.Productive anterior and posterior enthesopathy.Bridging osteophytes.Selective ossification of longitudinal ligament.Reactive arthropathy of (prior) professional soccer player.

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Case of the Day(sm)

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Neck pain

Here are some T-spine and L-spines on the same patient. Click to enlarge.

Can you select the most likely diagnosis?

Ankylosis spondylitis.Psoriatic arthritis.Diffuse idiopathic skeletal hyperostosis.Lyme disease.Vitamin D poisoning.

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Case of the Day(sm)

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Neck pain

Findings: C-Spine: Large bridging osteophytes on the anterior segments of the vertebral bodies with minimal posterior vertebral body and posterior element involvement. No disc height loss. T-spine: Large anterior and lateral bridging osteophytes with preservation of disc spaces. L-Spine: Some minimal anterior end-plate hypertrophy.

Differential diagnosis:

Diffuse idiopathic skeletal hyperostosis (DISH)
Ankylosis spondylitis
Degenerative disc disease
Psoriatic arthritis
Reactive arthritis

Diagnosis: Diffuse idiopathic skeletal hyperostosis

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Case of the Day(sm)

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Neck pain

Key points - DISH:

Characterized by "flowing" anterior (C-spine) or anterolateral (T-spine) osteophytes bridging four or more vertebral bodies
Most common in thoracic spine, usually right side > left side. Thought to be due to aortic pulsations Cervical spine 60-80 % involvement. Lumbar spine rarely has bridging osteophytes but commonly has anterior vertebral body osteophytes
No erosive changes. Degenerative disc changes may be present from concomitant degenerative disc disease but osteophytes are out of proportion to disc height loss and other DDD findings
Extra-axial involvement of pelvis, knee, shoulder, hand, feet is common. Changes include bony proliferation or "whiskering," osteophyte formation, and ligament, ossification

References:

StatDx
Up-to-date,
Mader R, Sarzi-Puttini P, Atzeni F, Olivieri I, Pappone N, Verlaan JJ, Buskila D. Rheumatology (Oxford). 2009 Dec;48(12):1478-81. Epub 2009 Sep 25.
Taljanovic MS, Hunter TB, Wisneski RJ, Seeger JF, Friend CJ, Schwartz SA, Rogers LF.
AJR Am J Roentgenol. 2009 Sep;193(3 Suppl):S10-9, Quiz S20-4.

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