Unusual cause of dysphagia and dysphonia

Abstract

Forestier's disease is an idiopathic noninflammatory condition associated with enthesopathy leading to hyperostosis of the vertebrae and peripheral skeletal system. The disease tends to affect elderly individuals and remains asymptomatic in most of the cases. Uncommonly, the patient may present with upper aerodigestive symptomatology, usually dysphagia. In elderly individuals, the disease may closely mimic upper aerodigestive tract malignancy, which should be actively excluded. In our patient, the hypopharyngeal soft tissue distortions created by the bony hypertrophy shifted the clinicoradiological suspicion towards malignant pathology. The current case presents the diagnostic dilemma associated with the disease and the need to keep the possibility of severe cervical bony hypertrophy as a cause of upper aerodigestive symptoms in mind.

Keywords: ear; endoscopy; nose and throat/otolaryngology; oesophageal cancer; orthopaedics; radiology.

Figure 1

(A) Contrast-enhanced CT scan of the neck at C5 level, showing obliterated Pyriformis sinus (hyperostosis marked with asterix). (B) Direct laryngoscopic view showing mucosa covered bulge (*) over the posterior pharyngeal wall at the level of supraglottic larynx, obscuring the view of the Pyriformis sinus on the left side.