Diffuse Idiopathic Skeletal Hyperostosis (DISH)

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1) Clinical Complaint:  Thoracic pain and stiffness in a 61-year old white male.   Findings:  Classic finding of ossification of the anterior longitudinal ligament (ALL) showing the flowing ossification that is described as “dripping candle wax“.  Disc heights are maintained.  Diffuse idiopathic skeletal hyperostosis differs from ankylosing spondylitis (AS) because DISH spares the sacroiliac joints.  Ankylosing spondylitis also has much thinner syndesmophytes, as opposed to these thicker enthesopathies.

DISH with dripping candle wax vs normal thoracic

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