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Diffuse idiopathic skeletal hyperostosis (DISH) is an ankylosing disease of unresolved pathophysiology. DISH tends to occur more in men and in those with diabetes, obesity, metabolic syndrome, gout, hypertension, and advanced age. Generally asymptomatic, or with only minimal symptoms such as morning stiffness, lumbar pain, or reduction in range of motion of the thoracolumbar spine, DISH can produce tracheal and esophageal compression from large peripheral enthesophytes. The differential diagnosis is limited when proper radiographs are made. Treatment is generally nonoperative except in patients with compression of the trachea or the esophagus.