title: An unusual and rare cause of acute airway obstruction in the elderly: Forestier's disease.
abstract: BACKGROUND
  Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is an ossifying disease of unknown etiology affecting mainly elderly men. It is characterized by hypertrophic anterior vertebral osteophytes with ossification of the spinal anterior longitudinal ligament. Hypertrophic osteophytes can encroach on the aerodigestive tract, leading to significant swallowing and respiratory symptoms.
  
  
  OBJECTIVE
  Acute stridor and respiratory compromise requiring a surgical airway have rarely been reported in patients with DISH. This entity, although rare, should be in the differential diagnosis of acute airway obstruction, particularly in the elderly.
  
  
  METHODS
  We describe a case of a 91-year-old patient who was transferred to the Emergency Department at Tufts Medical Center with acute stridor. A computed tomography scan of the neck prior to transfer revealed a large anterior cervical osteophyte causing significant airway narrowing. Fiberoptic evaluation confirmed the radiologic finding of near-complete airway obstruction. The patient's respiratory status rapidly deteriorated and he subsequently underwent an emergent awake tracheostomy to secure his airway.
  
  
  CONCLUSIONS
  Given the rarity of DISH and the increase in life expectancy, clinicians should be aware of this disease entity and its potential for acute life-threatening respiratory presentation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Walid I
authors.initials: WI
authors.lastname: Dagher
authors.affiliation: Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Viviane G
authors.initials: VG
authors.lastname: Nasr
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Anju K
authors.initials: AK
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Flis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Wein
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D004057:Hyperostosis, Diffuse Idiopathic Skeletal / Q000150:complications*; D008297:Male; D011859:Radiography; D012135:Respiratory Sounds / Q000209:etiology
keywords: Forestier's disease; acute airway obstruction; diffuse idiopathic skeletal hyperostosis; stridor; tracheostomy