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PubMed1990

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (chi 2 = 5.90, P less than 0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, chi 2 = 4.06, P less than 0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, chi 2 = 6.64, P less than 0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance.

Arthrography↗
PubMed1994

Cortical hyperostosis: a complication of prolonged prostaglandin infusion in infants awaiting cardiac transplantation.

BACKGROUND: Infants awaiting heart transplantation for congenital heart disease frequently require prostaglandin E1 (PGE1) infusion for prolonged periods. As a result, complications of prolonged PGE1 infusion, such as cortical hyperostosis, are being encountered more commonly. OBJECTIVE: To determine the incidence and severity of cortical hyperostosis in newborns requiring prolonged PGE1 infusion. METHODS: Chest radiographs of 86 infants receiving PGE1 infusion awaiting heart transplantation were reviewed. The chest radiographs were graded for the severity of cortical hyperostosis (no bony changes, minimal hyperostosis, or severe hyperostosis). Duration of PGE1 infusion, total PGE1 dose, and highest alkaline phosphatase were recorded for each patient. Infants were arbitrarily divided into three groups according to the duration of PGE1 infusion (< 30 days, 30 to 60 days, > 60 days). RESULTS: Fifty-three of the 86 infants (62%) had radiologic evidence of cortical hyperostosis. Forty-two of 80 infants (53%) had elevated alkaline phosphatase. The percentage of infants with hyperostosis increased with increasing duration of PGE1 infusion (42% at < 30 days; 87% at 30 to 60 days; 100% at > 60 days). The incidence and severity of cortical hyperostosis were related (by Kruskal-Wallis) to the duration of PGE1 infusion (P < .0001) and the total dose of PGE1 received (P < .0001). The highest alkaline phosphatase levels were observed in infants with the most severe grades of hyperostosis (P < .0001). The percentage of infants with elevated alkaline phosphatase increased with greater severity of hyperostosis (26% of infants with no bony changes, 59% with minimal changes, and 85% with severe changes). Two infants had symptomatic bone tenderness or swelling mimicking osteomyelitis. CONCLUSION: It is concluded that cortical hyperostosis is a frequent, often asymptomatic, side effect of prolonged PGE1 infusion that should be evaluated in any infant on long-term PGE1 therapy. When symptoms occur in infants awaiting transplantation, osteomyelitis must be excluded rapidly to avoid an unnecessary delay in transplantation.

Alprostadil↗
PubMed2004

[Ankylosed spine fractures with spondylitis or diffuse idiopathic skeletal hyperostosis: diagnosis and complications].

PURPOSE OF THE STUDY: Spinal fractures in patients with ankylosing spondylitis or idiopathic skeletal hyperostosis can raise difficult diagnostic and therapeutic problems. Spinal fracture is well known in ankylosing spondylitis but exceptional in diffuse idiopathic skeletal hyperostosis. The purpose of the present work was to identify clinical and radiological features in patients with ankylosing spondylitis, to determine whether similar risks and clinical expression are observed in patients with diffuse idiopathic skeletal hyperostosis, and to present a radiological classification of these fractures. We did not assess therapeutic methods in the present study. MATERIAL AND METHODS: Forty-eight fractures in 48 patients were observed over a period of 17 years. Twenty patients (mean age 62 years) had ankylosing spondylitis and 28 patients (mean age 81 years) had diffuse idiopathic skeletal hyperostosis. A fall was the immediate cause of the fracture in more than half of the patients. No notion of trauma could be identified in six patients. The radiological classification was established as follows; type I open-wedge anterior fracture, type II "sawtooth" fracture, type III occult or radiologically invisible fracture, type IV non-specific fractures comparable to other spinal fractures. A computed tomography was obtained in all patients seen after 1992 and magnetic resonance imaging was performed in case of suspected extradural hematoma. The ASIA classification (as modified by Frankel) was used for cord injuries. Clinical course and complications were noted. RESULTS: Diagnosis was established the day of fracture in 32 patients (12 spondylitis and 20 hyperostosis) and between day 2 and 30 for 16 (8 spondylitis and 8 diffuse idiopathic skeletal hyperostosis). The radiological classification was: type I n=30, type II n=4, type III n=8, type IV n=6 (one odontoid fracture, five compression fractures). Three patients had extradural hematomas (2 spondylitis and 1 hyperostosis). Thirty-four patients (11 spondylitis and 23 hyperostosis) had cord injuries, including 16 with a symptom-free interval. The ASIA classification was: type A n=4, type B n=6, type C n=20, type D n=4. Thirty-two patients died within the first three months after spinal fracture (10 spondylitis and 22 hyperostosis), due to bed rest related complications in 30. One patient died after rupture of an aortic aneurysm. DISCUSSION: Spinal fractures in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis generally occur spontaneously or after low-energy trauma. Subsequent complications have serious consequences. Late diagnosis either results from missing a radiologically visible fracture or from the presence of an occult "paper thin" fracture. We do not have experience with diagnostic scintigraphy or magnetic resonance imaging. In our opinion, repeating standard x-rays the second and third weeks and use of a spiral scan or multiple spiral scan could provide early diagnosis. CONCLUSION: The possible diagnosis of spinal fracture should be explored very extensively in patients with a symptomatic ankylosed spine who present symptoms compatible with spinal fracture, with or without trauma.

Adult↗
PubMed1992

Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study.

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, chi 2 = 5.32, P less than 0.025, n = 85, olds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, chi 2 = 4.51, P less than 0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus 13%, chi 2 = 0.75, NS, OR = 1.84 (95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Aged↗
PubMed1991

[Association of lumbar canal stenosis and ankylosing vertebral hyperostosis. Results of a multicenter study].

The authors report data collected in a study of the association of narrow lumbar canal and vertebral hyperostosis. Five centres (Montpellier, Toulouse, Lille, Lyons and Paris) participated in this cooperative study which was both retrospective and prospective. Grid case forms were sent to homogenise the date provided. Two hundred and sixty nine cases of symptomatic lumbar canal stenosis were collected; 89 (33 per cent) had hyperostosis. Hyperostosis was definite in 74 cases and probable in 15 other cases. Certain radiological and/or CT scan morphological factors seen frequently in the hyperostosis patients group led us to undertake a second study in 2 of the 5 centres (Montpellier and Toulouse) in order to identify their specificity. Twenty eight items were adopted and studied by 3 different evaluators (2 rheumatologists and one radiologist) in the X-ray films and CT scan documents of 100 patients with acquired lumbar canal stenosis with or without hyperostosis (46 and 54 cases respectively). The most discriminative appearances, which we suggest as diagnostic criteria of narrow lumbar canal with hyperostosis concern anterior and/or posterolateral marginal somatic bone proliferations on the non-articular surfaces of the posterior apophyses and ossifications of the posterior joint capsule and of the ligaments (ligamentum flavum--posterior longitudinal ligament--supraspinous ligament). Four of these 6 criteria are necessary to make the diagnosis of lumbar stenosis with hyperostosis. The radiological and CT scan appearances of lumbar hyperostosis appear to differ from ordinary degenerative changes of osteoarthrosis and hyperostosis may be held responsible for compression of the dural cul-de-sac.

Humans↗
PubMed2006

Hyperostosis may affect prognosis after primary endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVE: To investigate the independent effect of hyperostosis on outcome after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The medical records of 81 consecutive patients who had undergone primary ESS for CRS were reviewed retrospectively. Sinus CT scans were evaluated for the presence of hyperostosis to investigate the association with postoperative outcomes. The independent effect of hyperostosis on surgical outcome was analyzed, controlling for possible confounding factors with a multiple logistic regression model. RESULTS: Sixty percent of the patients showed hyperostosis, and there was a statistically significant association between the hyperostosis and postoperative outcome (P = 0.035, chi(2) test), which was confirmed after adjustment for the possible confounding factors (P = 0.048, odds ratio [OR] = 3.19, logistic regression analysis). CONCLUSIONS: Our study suggests that patients with CRS who have hyperostosis may have a poorer surgical outcome than those without hyperostosis. EBM RATING: B-2b.

Adult↗
PubMed1976

[Hyperostosis triangularis ilii -- a sacro-iliac stress phenomenon Part. 2 (Incidence, prognosis, pathogenesis, aetiology, tracer studies, differential diagnosis) (author's transl)].

The anterior iliac margin adjacent to the sacro-iliac joint contains a physiological zone of hyperostosis. Its shape is that of a triangular pyramid. Because of its small size, it is radiological invisible, but is nevertheless an indication of the presence of normal stresses passing from the mass of the trunk to the lower extremities. If for any reason, such as is described in this paper, the stresses on the hyperostosis zone are increased, the latter becomes enlarged, while still keeping its shape. It then appears on the radiograph as hyperostosis triangularis ilii. In approximately 50% of cases there is a simultaneous but variable sacral hyperostosis. Observations on 40 patients, together with two autopsies and radionucleide investigations suggest that hyperostosis triangularis ilii represents a potentially reversible bone reaction of the physiological hyperostosis of the anterior iliac margin. The clinical differential diagnosis raised by the radiological finding of a "triangular ilium hyperostosis" is discussed.

Adult↗
PubMed1993

Hyperostosis of ribs: association with vertebral ossification.

OBJECTIVE: Costal hyperostosis occurring with vertebral disorders, although not well known, has been described in patients with diffuse idiopathic skeletal hyperostosis (DISH). Our purpose was to examine the possible association of similar hyperostosis in other spinal conditions. METHODS: We investigated the frequency of hyperostotic rib changes on routine radiographs in 191 patients with various spinal disorders, including DISH (51 cases), ankylosing spondylitis (AS) (58 cases), psoriasis (21 cases) and quadriplegia (61 cases), and in a healthy control group (191 cases). RESULTS: Results showed that the frequency of rib hyperostosis was significantly higher in DISH (21.6%), AS (10.3%) and quadriplegia (6.6%) than in the healthy control group (0.5%). There was no significant difference in the frequency of right and left-sided involvement. The main radiographic features were a short segment of cortical thickening and sclerosis, which predominated in the medial aspect of the posterior portion of the rib. Some patients had a long segment of bone enlargement and extensive sclerosis. The resulting radiographic features simulated the appearance of Paget's disease. Osseous excrescences of adjacent costovertebral articulations were significantly related to the rib hyperostosis, seen in 73% of instances of rib involvement. CONCLUSION: Our observations suggest that diseases that lead to bone formation and resultant hypomobility of costovertebral articulations are associated with rib hyperostosis.

Adult↗
PubMed1992

Porotic hyperostosis: a new perspective.

Porotic hyperostosis is a paleopathologic condition that has intrigued researchers for over a century and a half. It is now generally accepted that anemia, most probably an iron deficiency anemia, is the etiologic factor responsible for lesion production. Although there can be a number of factors involved in the development of iron deficiency anemia, a dietary explanation has often been invoked to explain the occurrence of porotic hyperostosis in past human skeletal populations. In fact, porotic hyperostosis has been referred to as a "nutritional" stress indicator. Traditionally those groups with a higher incidence of porotic hyperostosis have been considered to be less successful in adapting to their environment or more nutritionally disadvantaged than other groups. A new perspective is emerging that is challenging previous views of the role of iron in health and disease, thus having profound implications for the understanding of porotic hyperostosis. There is a new appreciation of the adaptability and flexibility of iron metabolism; as a result it has become apparent that diet plays a very minor role in the development of iron deficiency anemia. It is now understood that, rather than being detrimental, hypoferremia (deficiency of iron in the blood) is actually an adaptation to disease and microorganism invasion. When faced with chronic and/or heavy pathogen loads individuals become hypoferremic as part of their defense against these pathogens, thus increasing their susceptibility to iron deficiency anemia. Within the context of this new perspective porotic hyperostosis is seen not as a nutritional stress indicator, but as a indication that a population is attempting to adapt to the pathogen load in its environment.

Anemia, Hypochromic↗
PubMed1999

Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion.

OBJECTIVE: Hyperostosis associated with intracranial meningiomas is a well-described entity. The cause, management, and prognosis of these bony changes have long been a point of controversy. Some authors have postulated that hyperostotic changes are secondary to the formation of the tumor and do not constitute invasion of the tumor into the bone. Determining this point has direct implications in the treatment of these patients, especially regarding surgical considerations. To more thoroughly evaluate this question, a study correlating the morphology to the radiology is necessary. METHODS: In this study, 51 patients underwent resection for meningiomas involving the cranial base. Preoperative radiographic evaluation using magnetic resonance imaging and/or computed tomography was performed, and areas of hyperostosis were identified. During the resection of the tumor, biopsies from these hyperostotic regions were sent for histological evaluation regarding the presence or absence of tumor invasion of the bone. RESULTS: Preoperative neuroradiological assessment identified 26 patients with radiographic evidence of hyperostosis. Histological examination of the resected bone showed tumor invasion in 35 patients, including the area of radiographically identified hyperostosis in 25 of the 26 patients. The floor of the middle fossa was a specific area of low sensitivity for preoperative assessment of associated hyperostosis. CONCLUSION: These results indicate that hyperostosis associated with meningiomas involving the cranial base are caused by tumor invasion of the bone histologically.

Adult↗
PubMed2002

Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis.

STUDY DESIGN: A rare case of retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis is presented. OBJECTIVE: To discuss the pathomechanism of retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis. SUMMARY OF BACKGROUND DATA: Reports describing craniovertebral manifestations of diffuse idiopathic skeletal hyperostosis are quite rare. Only two cases of an atlantoaxial subluxation and one case of an odontoid fracture have been reported. Myelopathy resulting from retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis has not been reported previously. METHODS: A 74-year-old man presented with spastic tetraparesis caused by a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. Transoral removal of the extradural mass combined with a dorsal atlantoaxial fusion was performed using a titanium frame with sublaminar cable wiring. RESULTS: Yellowish amorphous material extruded from between the odontoid process and the arch of C1 when the anterior capsule had been incised. The retro-odontoid mass was very firmly attached to the hypertrophied ligaments. The mass therefore had to be sharply dissected away to expose the dura. The histologic appearance of the mass consisted of poorly cell-degenerated ligament, fibrocartilage, and fibrin. There was a focal proliferation of small vessels, but no significant inflammatory component and no evidence of neoplasia. The ligaments appeared fibrillated, disintegrated, and fragmented. After surgery, the patient's neurologic function improved. CONCLUSIONS: This is the first reported case of a retro-odontoid pseudotumor combined with diffuse idiopathic skeletal hyperostosis. The secondary transfer of mechanical stress to the atlantoaxial segment was presented as a pathomechanism underlying the formation of this retro-odontoid pseudotumor.

Aged↗
PubMedDate not supplied

[Familial infantile cortical hyperostosis (Caffey's disease) with osteolytic lesions of the skull].

BACKGROUND: The parietal and frontal bones are rarely affected in infantile cortical hyperostosis. CASE REPORTS: Case n. 1: A 14-day-old boy developed a swelling of the left eyelid that extended to the face in a few days. It was tender and associated with fever. Laboratory findings were increased (RBC sedimentation rate and other signs of inflammation). CT scan of the sinuses, soft tissues and bones was normal, but at the age of 23 days minimal patches of rarefaction were seen on X-rays of the frontal bones. These lacunar areas gradually extended, with the inflammation persisted. A new CT scan at 6 months of age confirmed the existence of lacunar areas in the skull, but failed to find any lesions of the mandibles or nasal bones. At that time, scintigraphy showed inflammatory lesions of the skull and ribs. All clinical, laboratory and radiological findings spontaneously disappeared within 3 years. Case n. 2: Similar swellings of the face developed at the age of 15 days in the brother of case n. 1. The laboratory findings were identical to those for his brother, and there were minimal lytic areas of the vault of skull without any other lesions. At 3 months of age, X-rays confirmed the existence of skull lesions and showed cortical hyperostosis of the left humerus. Similar cortical hyperostosis of nasal bones appeared at the age of 8 months, while the inflammatory syndrome persisted. All findings gradually and spontaneously disappeared within 18 months. CONCLUSIONS: Cortical hyperostosis are usually most prominent in the lower extremities in cases of familial infantile cortical hyperostosis. The lesions were largely confined to the skull in our cases, with no lesions of the mandible. The disease was only identified in the first case after a protracted course with unpredictable remissions and relapses and the discovery of the cortical hyperostosis in his brother.

Humans↗
PubMed1976

The diagnostic value of hyperostosis in midline subfrontal meningioma.

Roentgenologic analysis of 66 patients with proved midline subfrontal meningioma indicates a very high incidence of hyperostosis. A total of 63 patients (95%) showed varying degrees of hyperostosis involving the cribiform plate, planum sphenoidale, or tuberculum sellae (including the chiasmatic sulcus). The planum sphenoidale is the most common site of hyperostosis (59%). In 19 cases (29%), the region of hyperostosis did not correspond to the site of tumor attachment. Mild or localized hyperostosis may be apparent only on tomograms. Small "blistering" and "saw-tooth-like" osteoma formation are reliable early signs of midline subfrontal meningioma; conversely, midline subfrontal meningioma can be virtually ruled out if hyperostosis is absent.

Adult↗
PubMed1976

Juxtasellar hyperostosis of non-meningiomatous origin.

Seven patients are described who had juxtasellar hyperostosis with visual disturbance secondary to non-meningiomatous lesions. Two had chromophobe adenomas, one craniopharyngioma, one carcinoma of the sphenoid sinus, one a thrombosed aneurysm of the intracavernous portion of the internal carotid artery, one epidermoidoma of the orbit, and one chondroblastoma of the anterior clinoid process. The diagnosis of meningioma was entertained initially on the basis of hyperostosis plus visual impairment. Careful evaluation of hyperostosis is essential for correct diagnosis of meningioma, according to our experience. Suprasellar meningiomas almost invariably produce irregular hyperostosis of the planum sphenoidale, often associated with serration and blistering. Sphenoid meningioma, when it is sclerotic, always shows thickening or expansion of the sphenoid wings. Therefore, in the absence of typical meningiomatous hyperostosis, one can readily differentiate non-meningiomatous hyperostosis from true meningioma.

Adenocarcinoma↗