Clinical Image: Esophageal Compression Secondary to Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disorder characterized by ossification of spinal ligaments and entheses. Although thoracic involvement is most common, cervical disease may rarely cause clinically significant esophageal compression and dysphagia. We present the case of a 73-year-old man with progressive dysphagia whose videofluoroscopic swallowing study, cervical computed tomography, and magnetic resonance imaging demonstrated prominent anterior cervical osteophytes causing marked pharyngoesophageal compression, consistent with DISH. This case highlights the importance of considering cervical DISH in the differential diagnosis of mechanical dysphagia in older adults and illustrates the value of cross-sectional imaging in establishing the diagnosis and guiding multidisciplinary management.