Forestier disease

an unusual cause of upper airway obstruction

Caminos, Carlos Beaumont MD
Cenoz, Idoya Zazpe MD, PhD
Louis, Clint Jean MD
Otano, Tomás Belzunegui MD, PhD
Esáin, Bernabé Fenández MD
Pérez de Ciriza, María Teresa Fortún MD, PhD

^aEmergency Department, Hospital of Navarra, Pamplona, Navarra 31008, Spain
^bDepartment of Neurosurgery, Hospital of Navarra, Pamplona, Navarra 31008, Spain
^cEmergency Department, Hospital of Navarra, Pamplona, Navarra 31008, Spain

This article was presented at the 13th Congress of the Spanish Society of Neruosurgery (Valencia, Spain; May 28-30, 2008).

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American Journal of Emergency Medicine 26(9):p 1072e1-1072e3, November 2008.

We report the case of a 75-year-old man who presented at the emergency department complaining of difficult breathing, especially when in supine position. He had cough, dysphonia, and dysphagia for fluids in the last few months. After ruling out other causes of dyspnea, a lateral cervical radiograph was performed that showed large osteophytes compressing the airway, which was confirmed by cervical computed tomography. Marked improvement of symptoms was observed after resection of the osteophytes compressing the airway. Diffuse idiopathic skeletal hyperostosis, or Forestier disease, is an ossifying disease of ligaments and tendons and affects mainly elderly men. Anterior longitudinal ligament ossification is characteristic. Although it is asymptomatic in some occasions, the disease may produce dysphagia, dysphonia, and exceptionally breathing difficulties due to airway compromise. In these cases, early surgery is recommended to alleviate airway obstruction.