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Cause of Dysphagia: Diffuse Idiopathic Skeletal Hyperostosis

机译：吞咽困难的原因：弥漫性特发性骨骼肥大

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Case 1: A man aged 77 years was admitted to hospital with dysphagia. The patient was having difficulties in swallowing solid and liquid foods for two years without fluctuation of this condition. He was diagnosed as having myasthenia gravis (MG) and he saw no benefit from pyridostigmine (240 mg/day). Neurologic examination showed hypophonia, positive gag reflex, decreased vibration sense in all extremities (6 seconds), and absence of deep tendon reflexes in the lower extremities and examination of the nasopharynx revealed the existence of a smoothly-bordered mass. Complete blood count, biochemical parameters and tests of collagen tissue were normal and he was seronegative for anti-acetylcholine receptor antibody. Repetitive nerve stimulation was normal. No reason for dysphagia was found in an endoscopic examination. A lateral cervical direct radiograph revealed osteophytic spurrings, ligamentous calcifications, and bridging osseous hypertrophic changes, predominantly in the anterior parts of vertebral bodies between C3-C7. Nasopharynx computerized tomography (CT) showed large osteophytic spurrings that pushed the hypopharynx forward, and osteophytic spurrings and calcification of the posterior longitudinal ligament in the spinal canal at the level of the C3-C4 vertebra (Figure 1a, 1b, 1c). The patient was diagnosed as having diffuse idiopathic skeletal hyperostosis (DISH) in light of the clinical and laboratory data.
机译：案例1：一名77岁的男性因吞咽困难入院。两年来，患者在吞咽固体和液体食物时都遇到了困难，而且这种状况没有波动。他被诊断患有重症肌无力（MG），并没有发现吡啶斯的明（240毫克/天）的益处。神经系统检查显示，所有肢体（6秒）均表现为低音，gag反射阳性，振动感减弱，下肢无深层肌腱反射，鼻咽部检查显示存在平滑边界的肿块。他的全血细胞计数，生化参数和胶原组织测试均正常，他的抗乙酰胆碱受体抗体呈血清阴性。重复性神经刺激正常。在内窥镜检查中未发现吞咽困难的原因。颈椎侧位X线片显示骨赘刺激，韧带钙化和桥接骨性肥大变化，主要发生在C3-C7之间的椎体前部。 Nasopharynx计算机断层扫描（CT）显示大的骨赘刺激将下咽向前推进，并且骨赘刺激和C3-C4椎骨水平的椎管后纵韧带钙化（图1a，1b，1c）。根据临床和实验室数据，该患者被诊断为弥漫性特发性骨骼肥大（DISH）。

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