Introduction

Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory condition characterized by ossification of spinal ligaments and excessive osteophyte formation, predominantly affecting the thoracic spine, although other spinal regions may also be involved [1]. Clinically, DISH is often asymptomatic; however, it can occasionally cause pain, stiffness, and functional impairment. Cervical involvement may lead to significant complications, including airway obstruction, dysphagia, or, in rare cases, vocal cord dysfunction [2].

The pathophysiology of DISH is complex, involving both mechanical and metabolic factors in the development of abnormal bone proliferation. Associations with advanced age, male sex, metabolic disorders, and diabetes mellitus have been documented [3,4]. Imaging studies, particularly computed tomography (CT) and magnetic resonance imaging (MRI), are essential for accurate diagnosis and for assessing the extent of osteophytic compression on the esophagus and airway [2,5].

Recent literature emphasizes the importance of early recognition of cervical DISH in patients presenting with unexplained dysphagia to prevent serious complications such as aspiration pneumonia and respiratory compromise [1,2]. In this report, we present the case of a 73-year-old male with progressive dysphagia, in whom endoscopy, CT, and MRI revealed prominent anterior cervical osteophytes consistent with DISH, causing marked posterior pharyngoesophageal compression. This case highlights the necessity of correlating clinical findings with imaging to ensure timely diagnosis and management.