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Diffuse Idiopathic Skeletal Hyperostosis (DISH)

 

 

  • Laminated, flowing osteophyte formation

  • Must involve four contiguous vertebral bodies

  • Osteophytes are usually quite thick

  • Involves lower cervical and lower thoracic spine most frequently

    • Disc space height tends to be maintained

  • “Whiskering” at the sites of tendinous insertion

    • Pelvic involvement

      • Crests

      • Ischial tuberosities

      • Iliolumbar ligaments

      • Lesser trochanter

    • Deltoid tuberosities of humerus

    • Olecranon spurs

  • DDX:

    • Ankylosing spondylitis

    • Acromegaly

      • May produce osteophytes but they are not flowing

    • Fluorosis may produce osteophytes, whiskering and ligamentous ossification

      • But all bones are uniformly increased in density

 

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