DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS

 

AP radiograph of the pelvis reveals extensive fluffy or "whiskering" enthesopathy of the iliac crests (red arrows), ischial tuberosities (yellow arrows), and the trochanters (black arrows). Note is also made of ossification of the iliolumbar ligament (blue arrow). Importantly, both sacroiliac joints appear normal. These findings are in keeping with diffuse idiopathic skeletal hyperostosis (DISH).

Diffuse Idiopathic skeletal hyperostosis (DISH) is a bone-forming diathesis primarily affecting the spine, with ossification of tendons and ligaments.  Most of us are familiar with the spinal findings; however there are extraspinal manifestations as well such as hyperostosis at ligament attachments in the pelvis, calcaneus, tarsal bones, ulnar olecranon and patella.

  • Radiographic manifestations in the pelvis are usually symmetrical and include:
  • Enthesophytes (yellow arrows): Irregular outgrowths or whiskering seen most commonly at the iliac crests, ischial tuberosities, and the trochanters.
  • Para-articular osteophytes (red arrows): Broad and well-defined. Seen at the acetabular margins, sacroiliac joints, and pubic symphysis. Sacroiliac osteophytes tend to affect the inferior margins.
  • Ligamentous ossification: Iliolumbar (black arrows) and sacrotuberous ligaments.

Usually these are incidental findings without significant morbidity.

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2019-11-22 12:04
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