Forestier disease: an unusual cause of upper airway obstruction

We report the case of a 75-year-old man who presented at the emergency department complaining of difficult breathing, especially when in supine position. He had cough, dysphonia, and dysphagia for fluids in the last few months. After ruling out other causes of dyspnea, a lateral cervical radiograph was performed that showed large osteophytes compressing the airway, which was confirmed by cervical computed tomography. Marked improvement of symptoms was observed after resection of the osteophytes compressing the airway. Diffuse idiopathic skeletal hyperostosis, or Forestier disease, is an ossifying disease of ligaments and tendons and affects mainly elderly men. Anterior longitudinal ligament ossification is characteristic. Although it is asymptomatic in some occasions, the disease may produce dysphagia, dysphonia, and exceptionally breathing difficulties due to airway compromise. In these cases, early surgery is recommended to alleviate airway obstruction.