History Page: Leaders in MSK Radiology

This history page in the series “Leaders in MSK Radiology” is dedicated to the memory and achievements of the French physician Jacques Forestier, whose name is connected with the medical eponym Forestier's disease, later referred to as diffuse idiopathic skeletal hyperostosis.

Unusual cause of dysphagia and dysphonia

Forestier’s disease is an idiopathic noninflammatory condition associated with enthesopathy leading to hyperostosis of the vertebrae and peripheral skeletal system. The disease tends to affect elderly individuals and remains asymptomatic in most of the cases. Uncommonly, the patient may present with upper aerodigestive symptomatology, usually dysphagia. In elderly individuals, the disease may closely mimic upper aerodigestive tract malignancy, which should be actively excluded. In our patient, the hypopharyngeal soft tissue distortions created by the bony hypertrophy shifted the clinicoradiological suspicion towards malignant pathology. The current case presents the diagnostic dilemma associated with the disease and the need to keep the possibility of severe cervical bony hypertrophy as a cause of upper aerodigestive symptoms in mind.

Acute dyspnea as a manifestation of Forestier's disease. A case report.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor. In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82 years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4-C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed.

Combination of Forestier’s disease and laryngeal cancer: a rare clinical case

The objective of the scientific report is to describe a rare clinical case of a combination of Forestier’s disease (diffuse idiopathic skeletal hyperostosis) and laryngeal cancer that have common symptoms. Case report. A 68-year-old male patient presented with hoarseness lasting for a year. Indirect laryngoscopy revealed a vocal fold tumor. Histological examination confirmed well-differentiated keratinizing squamous cell carcinoma of the larynx. A 6-cm tumor was located in the projection of the right vocal fold and had no signs of invasion into the supraglottis, subglottis, and anterior commissure. No other focal disorders were detected. The patient has undergone endolaryngeal laser resection of the larynx and tracheostomy. After probe removal, the patient had swallowing difficulties with esophageal content passing to the trachea mainly due to organic changes in the cervical spine at the СЗ–С4 level, where there was a massive local calcification of the anterior longitudinal ligament. We also noticed severe movement restriction in the cervical spine: the amplitude of movements did not exceed 10°. The formation of the C3–C4 segment was removed via ventrolateral approach. Conclusion. Dysphagia, dysphonia, and dyspnea may indicate both malignant tumor and large osteophyte causing compression of the trachea and esophagus. In this case, no symptom resolution after tumor removal led to the suspicion of a second disease, namely Forestier’s disease.

Retro-odontoid pseudotumor (pannus) with Forestier’s disease presenting with severe tetraparesis: A case report and literature review

Background: A retro-odontoid pannus is often associated with inflammatory diseases. It can also have a noninflammatory cause due to chronic atlantoaxial instability. Case Description: Here, we report a patient with diffuse idiopathic skeletal hyperostosis and a severe noninflammatory retro-odontoid pannus who rapidly improved after posterior craniocervical decompression and arthrodesis. Conclusion: Transoral resection of the pannus, followed by posterior stabilization, is a common treatment for this condition. The pannus can, however, also reduce after posterior stabilization alone (e.g., craniocervical decompression).