Chest radiographs in two projections posteroanterior and lateral showed ventral deviation of the xiphoid process on the lateral view, explaining the mass-like protrusion palpated on the chest wall Figure 1. To exclude any bony lesion causing such symptoms, a CT scan of the thorax Siemens Somatom Spirit, multi-slice CT, Erlangen, Germany was performed and reformatted images in coronal, sagittal and axial planes were obtained.
On the sagittal images, the patient had a ventrally deviated xiphoid process confirming the lateral chest X-ray findings Figure 2. No other chest wall or upper abdominal mass was identified. Lateral X-ray shows hook-like anterior protrusion of the xiphoid process, which can be mistaken as a mass in the epigastric region on physical examination.
Thorax CT scan in the sagittal plane in reformatted image shows the hook-like anterior protrusion of the xiphoid process more clearly. This is considered an anatomic variation.
The xiphoid process was measured 4cm in the longitudinal dimension. No other pathologic condition was noted on the CT images. The patient was diagnosed as having the xiphoid syndrome according to the clinical and radiological findings.
Non-steroidal anti-inflammatory drugs were prescribed for 2 weeks and he was advised to avoid pressure on his xiphoid process while at work. The pain was relieved and his symptoms were reduced at follow-up after 3 weeks. At 3 months of follow-up, he mentioned that he used anti-inflammatory drugs only when he felt pain in his xiphoid region and that he had stopped using his anterior chest wall at work.
Trauma is an important factor in the aetiology of the xiphoid syndrome. Acceleration and deceleration injuries [ 1 ], blunt trauma to the chest [ 1 ], unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia [ 2 ], probably because of the muscular attachments to the xiphoid process.
Cardiac or thoracic surgery also involves trauma to the chest wall, which may change the morphology of the sternum and cause xiphodynia. Enomoto et al.
They suggested that the xiphoid process was separated from the sternum and pulled down inferiorly by the rectus abdominis muscle and then reconnected to the sternum, so that it was elongated [ 3 ], a mechanism, which they suggested was similar to distraction osteogenesis in limb-lengthening operations [ 3 ]. Our patient had no history of any cardiac or thoracic surgery, but a history of repeated microtrauma to the sternum incurred during his work while leaning against wood and exerting force with his anterior chest wall.
Microtraumas can result in stress fractures and may cause new bone formation. New bone formation may also occur as a response to an insult such as tumour, infection, certain drugs, some arthritic conditions as well as trauma [ 4 ].
According to our observations, after the patient ceased using his chest wall while cutting wood, pain relief was established by the third week of the follow-up and anti-inflammatory drugs had helped to diminish the inflammation and resulting pain.
In conclusion, an occupational history as well as thorough clinical and radiological assessment can be import ant for correctly diagnosing and identifying the cause of rare conditions like the xiphoid syndrome. This disorder may be seen in people performing hard physical work who use their chest wall, such as the carpenter in our case. Clinicians should be aware of this disorder and the diagnosis should be made by exclusion after careful examination and appropriate clinical investigation.
Well-known causes such as acceleration and deceleration injuries and blunt trauma, unaccustomed heavy lifting and aerobics have been known to precipitate xiphodynia, the latter two because of the muscular attachments to the xiphoid process. Repeated microtraumas to the bony parts of the body during heavy physical activity can result in stress fractures and resulting new bone formation.
People performing hard physical work who use their chest wall to exert force may be predisposed to the xiphoid syndrome. Simpson JK Hawken E. Xiphodynia: a diagnostic conundrum. Chiropr Osteopat ; 15 : Google Scholar. Howell J. Xiphodynia: a report of three cases.
J Emerg Med ; 16 : — Postoperative elongation of the xiphoid process—report of a case. An X-ray can reveal damage to the xiphoid process. If X-ray results are inconclusive, your doctor may recommend further testing. These tests can take pictures of the inside of your body and help identify masses, inflammation, and other abnormalities. Treatment for xiphoid process pain depends on the underlying cause and the severity of your symptoms.
If symptoms occur after a recent trauma, your doctor may prescribe a prescription anti-inflammatory to relieve pain, or recommend alternating between hot and cold therapy throughout the day. Your doctor may also suggest limiting certain activities until the injury heals. Modifying eating habits can treat xiphoid process pain associated with acid reflux disease.
Eat smaller meals five to six times a day and avoid certain trigger foods e. Acid reflux is also controllable with over-the-counter and prescription medications that reduce stomach acid and promote healing of the esophagus. Although the xiphoid process has a specific role in anatomy, a broken xiphoid process can cause serious problems, such as puncturing internal organs. Your doctor may recommend surgical removal for breaks or fractures.
This is a last resort procedure when other therapies fail. To perform this surgery, a surgeon makes an incision along the base of the xiphoid process. Using electrosurgical dissection, the surgeon cuts and releases the exposed xiphoid process from the sternum, and then uses electrocoagulation electric currents to stop bleeding. You may have bruising after surgery and tenderness until the wound heals.
Recovery times vary from person to person, but you may be able to resume normal activity within a few weeks. In one study, a year-old surfer was able to resume surfing 26 days after xiphoid process removal. They can help you uncover the underlying cause and then discuss your treatment options. Somatic pain is constant and involves superficial injuries. Visceral pain is vague and often feels like a deep squeeze, pressure, or aching.
Chest and abdominal pain may be caused by something as simple as gas. But it also could be the sign of GERD, a peptic ulcer, or something very serious,. There are some questions about the side effects of the "poly pill," which combines aspirin with three other drugs used to treat cardiovascular disease. COVID and anxiety can both lead to chest pain or tightness.
However, there are many less serious causes of a tight…. There may be some difficulty with the diagnosis due to the fact that the xiphoid could be mistaken for a lump or a hernia. Also, because of its proximity to several bone structures, it could be mistaken for a broken rib, especially where the pain is severe. Magnetic resonance imaging MRI or a computerized tomography CT scan will take care of the diagnosis nicely though. These tests can An x-ray can reveal damage to the xiphoid.
If the x-ray results are inconclusive, your doctor may recommend further testing. The treatment for xiphodynia depends on its cause. Generally, and especially in the case of an accident, a doctor may prescribe anti-inflammatory drugs to reduce the pain.
If it is caused by weight lifting, the doctor may also recommend that you avoid intense exercise or activities that put a strain on your xiphoid. Pain caused by acid reflux would ordinarily include recommendations to avoid foods that could trigger a reflux such as chocolates, peppermint and tomatoes.
Surgery may be considered as a last resort in the event of severe damage to the xiphoid such as its breaking. As mentioned earlier, if what you have is a painless bump, you may have no cause to worry. The bump, in this case, is most probably caused by a protruding xiphoid process, an entirely natural phenomenon. But some people are very self-conscious about what they fear may be perceived as a defect.
You may have heard or may think that doing some more exercise around your pecs and abs will hide the bump or make it less noticeable. Nothing can be further from the truth. When you exercise your pecs, only the muscles to either side of the sternum develop and get filled out.
The area along your sternum will maintain its depression so what you have after exercising that area may be a more prominent bump. The best thing to do is leave it alone. The bump is entirely natural and hardly anyone will notice it.
0コメント