Spinal Osteophytosis: An Uncommon Cause of Dysphagia

Images in Gas oen e ology and Hepa ology GE Po J Gas oen e ol 2022;29:215–216 Spinal Os eophy osis: An Uncommon Cause o Dysphagia And eia De Ma os a, b C is iane Macedo a Pa ícia A onso Mendes a, b a In e nal Medicine, Coimb a Hospi al and Uni e si y Cen e , Coimb a, Po ugal; b Clinical Medicine, Facul y o Medicine, Uni e si y o Coimb a, Coimb a, Po ugal Recei ed: No embe 19, 2020 Accep ed: Janua y 23, 2021 Published online: Ma ch 29, 2021 And eia De Ma os In e nal Medicine Coimb a Hospi al and Uni e si y Cen e PT–3200–408 Coimb a (Po ugal) a.ma ga ida_ma os @ ho mail.com © 2021 Sociedade Po uguesa de Gas en e ologia. Published by S. Ka ge AG, Basel ka ge @ka ge .com www.ka ge .com/pjg DOI: 10.1159/000514780 Keywo ds Spinal os eophy osis · O opha yngeal dysphagia Os eo i ose Ce ical: Uma Causa Incomum de Dis agia Pala as Cha e Os eo i ose ce ical · Dis agia o o a íngea A Caucasian 60-yea -old man, wi h a ca ee in house- building, p esen ed wi h mild, ch onic and p og essi e dysphagia, mani es ed by di icul y in swallowing solid ood o he las 6 mon hs. He had no ce ical pain, weigh loss, dysphonia, espi a o y complain s, p e ious su gical in e en ion, adio he apy, majo auma, myogenic o me abolic known causes o his symp om. The pa ien had a no mal ce ical and ches physical examina ion and neu ologic exam. A ba ium swallow es was i s ly pe - o med, e ealing a pos e io esophagus inden a ion due o an os eophy e o ma ion, which in e e ed wi h con- as p og ession. This exam also uled ou dys unc ion in mo ili y o a Zenke ’s di e iculum. Consequen ly, o be - e cha ac e ize he os eoa icula disease, he pa ien was submi ed o a compu ed omog aphy (CT) and ce ical magne ic esonance imaging (MRI) which e ealed de- gene a i e changes such as: an e io and la e al p o u- sion o e eb al discus, os eophy es om C3 o C5, un- ca h osis, and pos e io C3 o C6 in e apophysa y hy- pe ophic a h osis, wi hou ligamen calci ica ion o ce ical webs (Fig.1a–c). Finally, uppe diges i e endos- copy uled ou in insic abno mali ies, and ce ical ul a- sound was also no mal. Ce ical os eophy es occu in 20–30% o he gene al popula ion [1] and a e mos ly associa ed wi h di use id- iopa hic skele al hype os osis and ankylosing spondyli is [2]. Mos os eophy es o he an e io ma gin o he ce i- cal spine a e asymp oma ic. Ne e heless, ce ical os eo- phy es we e he cause o dysphagia in 11.7% o a s udied popula ion, wi h a mean age o 79 ± 8 yea s [3, 4], disclos- ing a possible unde ecognized e iology. In his ma e , acco ding o Lee e al. [5], pa ien s wi h his condi ion we e usually men (81%), wi h a mean age o 68 yea s and he C3 o C6 le el mos commonly in ol ed, ypically p esen ing wi h a long his o y o dysphagia. O he symp- oms include ood impac ion, dysphonia and espi a o y obs uc ion [2, 3]. The diagnos ic imaging app oach in- cludes a la e al X- ay, ba ium swallow, and ce ical CT o MRI. Su gical app oach may be a de ini e solu ion, bu die es ic ions may cause sa is ac o y imp o emen [1– 3, 5]. Ou pa ien was paucisymp oma ic and emains only wi h adap ed die . The au ho s highligh an e io ce ical os eophy osis as a di e en ial diagnosis o o o- pha yngeal dysphagia. This is an Open Access a icle licensed unde he C ea i e Commons A ibu ion-NonComme cial-4.0 In e na ional License (CC BY-NC) (h p://www.ka ge .com/Se ices/OpenAccessLicense), applicable o he online e sion o he a icle only. Usage and dis ibu ion o com- me cial pu poses equi es w i en pe mission. DeMa os/Macedo/A onsoMendes GE Po J Gas oen e ol 2022;29:215–216 216 DOI: 10.1159/000514780 S a emen o E hics The au ho s s a ed ha he subjec ga e in o med consen o publish his case. Con lic o In e es S a emen The au ho s ha e no con lic s o in e es o decla e. Funding Sou ces No unding was ecei ed. Au ho Con ibu ions All au ho s con ibu ed equally o da a acquisi ion, w i ing and app o al o he inal e sion o he pape and ag eed o all aspec s o he wo k in ensu ing ha ques ions ela ed o he accu acy o in eg i y o any pa o he wo k we e app op ia ely in es iga ed and esol ed. a b c Fig. 1. a C3 soma ic ma ginal os eophy e (whi e ci cle) on CT. b Ce ical MRI wi h an e io and la e al p o u- sion o he e eb al discus and os eophy es in C3 o C5. c Ba ium swallows wi h pos e io esophagus inden a ion a he le el o he os eophy e o ma ion. Re e ences 1 Akbal A, Ku a an A, Selcuk B, Gu can A, E - soz M, Akyuz M. The de elopmen o dyspha- gia and dysphonia due o an e io ce ical os- eophy es. Rheuma ol In . 2009 Jan; 29(3): 331–4. 2 Maka am N, Gohil R, Majumda S. Dyspha- gia due o oesophageal obs uc ion: A case e- po o unusual occupa ional ae iology. Ann Med Su g (Lond). 2015 No ; 4(4): 438–43. 3 Gige R, Dulgue o P, Paye M. An e io ce - ical os eophy es causing dysphagia and dys- pnea: an uncommon en i y e isi ed. Dyspha- gia. 2006 Oc ; 21(4): 259–63. 4 Hee Eun Choi, e al. Cha ac e is ics and Clin- ical Cou se o Dysphagia Caused by An e io Ce ical Os eophy e. Ann Rehabil Med. 2019 Feb; 43(1): 27–37. h ps://doi.o g/10.5535/ a m.2019.43.1.27. 5 Lee, Seung Ah, MD; Kim, Kyung Eun, MD; Paik, Nam-Jong, MD, PhD Dysphagia caused by mul ile el ce ical os eophy es. Am J Phys Med Rehabil. 2008 Jul; 87(7): 607. h ps://doi. o g/10.1097/PHM.0b013e31817c496b.