Insidious onset of xiphodynia with an idiopathic origin—a rare case report

Xiphodynia, a rare condition involving xiphoid process inflammation, is often associated with xiphoid region trauma, such as acceleration/deceleration injuries, weightlifting, or thoracic surgery-induced morphological changes. The literature remains scarce, with few reported cases. This paper presents a 62-year-old male with diabetes mellitus type 2 who presented to a clinic for an insidious onset, non-traumatic, non-radiating pain at the lower sternum/xiphoid process with an associated “lump” for over a year. The pain was exacerbated by the prone position and palpation/pressure to the area but was not crushing, burning or pleuritic. The patient denied any other symptoms to suggest the pain was cardiac, respiratory, or gastrointestinal in origin. On examination, a tender nodule was palpated over the xiphoid process without adjacent structure tenderness or associated skin changes. A sternum X-ray showed a prominent sternum surrounded by calcifications. Given the history, exam and imaging findings, the patient was diagnosed with xiphodynia. He then was prescribed topical diclofenac gel with significant pain relief at the six-month follow-up. This report presents a rare case of insidious onset xiphodynia. Only 24 cases of xiphodynia from 1955–2010 and 12 published cases were reported in the literature. Xiphodynia is a diagnosis of exclusion with drivers of pain similar to those found in the synchondrosis joint family, such as arthritis, osteochondritis/osteochondrosis, post-viral syndromes, trauma and autoimmune pathologies. Frequently, referred pain from internal organs could be mistaken for xiphodynia. After all causes of acute pathology are excluded, the treatment of xiphodynia should be directed toward the xiphisternal joint, starting with ice, rest and oral/topical analgesics, possibly accelerating stepwise to injections, radiofrequency ablation and xiphoidectomy. In conclusion, xiphodynia, presenting as insidious xiphisternal joint pain, is diagnosed after ruling out trauma, cardiopulmonary or gastrointestinal etiology. The treatment of xiphodynia is based on symptom presentation with conservative management as the first-line therapy.

Xiphodynia; Inflammation; Chronic pain; Chest pain

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