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

  • Abdulhameed Sami Qashqary1
  • Loc Lam2
  • Christian Vangeison1
  • Dan Sebastian Dîrzu3,4,*,
  • Emanuel N. Husu2,5

1Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA

2H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA

3UBB-Star Institute, “Babeș Bolyai” University Cluj-Napoca, 400347 Cluj Napoca, Romania

4Anesthesia and Intensive Care Department “Clinicilor 4—6” Emergency County Hospital Cluj-Napoca, 40006 Cluj Napoca, Romania

5Department of Clinical Sciences, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA

DOI: 10.22514/sv.2024.088 Vol.20,Issue 7,July 2024 pp.104-107

Submitted: 03 September 2023 Accepted: 04 February 2024

Published: 08 July 2024

*Corresponding Author(s): Dan Sebastian Dîrzu E-mail: dan.dirzu@ubbcluj.ro

Abstract

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.


Keywords

Xiphodynia; Inflammation; Chronic pain; Chest pain


Cite and Share

Abdulhameed Sami Qashqary,Loc Lam,Christian Vangeison,Dan Sebastian Dîrzu,Emanuel N. Husu. Insidious onset of xiphodynia with an idiopathic origin—a rare case report. Signa Vitae. 2024. 20(7);104-107.

References

[1] Maigne JY, Vareli M, Rousset P, Cornelis P. Xiphodynia and prominence of the xiphoid process. Value of xiphisternal angle measurement: three case reports. Joint Bone Spine. 2010; 77: 474–476.

[2] Ono R, Hamano H, Yarita T. Xiphodynia. Internal Medicine. 2022; 61: 131.

[3] Eulálio Filho WMN, Barbosa DJM, de Sousa Junior EC. Xiphodynia: a rare cause of epigastric pain. Internal and Emergency Medicine. 2018; 13: 127–128.

[4] Yapici Ugurlar O, Ugurlar M, Ozel A, Erturk SM. Xiphoid syndrome: an uncommon occupational disorder. Occupational Medicine. 2014; 64: 64–66.

[5] Lipkin M, Fulton LA, Wolfson EA. The syndrome of the hypersensitive xiphoid. New England Journal of Medicine. 1955; 253: 591–597.

[6] Waldman SD. Xiphodynia. In Waldman SD (ed.) Atlas of Uncommon Pain Syndromes (pp. 193–194). 3st edn. Elsevier: Philadelphia. 2014.

[7] Koren W, Shahar A. Xiphodynia masking acute myocardial infarction: a diagnostic cul-de-sac. American Journal of Emergency Medicine. 1998; 16: 177–178.

[8] Sklaroff H. Xiphodynia—another cause of atypical chest pain: six case reports. Mount Sinai Journal of Medicine. 1979; 46: 546–548.

[9] Howell JM. Xiphodynia: a report of three cases. The Journal of Emergency Medicine. 1992; 10: 435–438.

[10] Ramirez C, Drake DF. Poster 428 treating xiphodynia with pulsed radiofrequency ablation (RFA): a case report. PM&R. 2016; 8: S301.

[11] Garssen FP, Aalders MB, van der Poel MJ, Zuidema WP. Operative results after xiphoidectomy in patients with xiphodynia. Asian Cardiovascular and Thoracic Annals. 2021; 29: 779–783.

[12] Olivencia-Yurvati AH. Xiphodynia surgical management. International Surgery. 2018; 102: 412–416.

[13] Dorn P, Kuhn MA, Schweizer BA, Schmid RA, Kocher GJ. Xiphoidectomy for intractable xiphodynia. World Journal of Surgery. 2018; 42: 3646–3650.


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