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Does this sound like xiphoid process?
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Does this sound like xiphoid process?

I have been dealing with a lump on my lower sternum for about 6 months now. You can feel it on the outside. It started small. But its definitely grown quite a bit. Seen like 8 different doctors. One of em said it was a cartilage build up. But I've been on two different strong steroids for that and had a cortisone injection done right into it. Oh my god the next day it hurt so damn bad if I even brushed up against it I wanted to scream. Its so painful all the time and if I sit back or lay down on my back I my chest tightens up and its hard to breathe. I have had x-rays done, blood work a couple times, and a cat scan done and nothing has showed up. This started on my right side. But Im pretty sure its starting to grow on the left side as well. Any suggestions?
242587_tn?1355427710
That all the testing done thus far is normal/negative is very good news but that hasn’t solved your problem.  The best advice I can give is that you seek consultation with a Board Certified Rheumatologist.  One cautionary note.  What you are experiencing can be worsened by touch or, especially, pressure.  The temptation to engage in either activity should be resisted.  

You describe the pain as located at the bottom of the sternum.  The structure at the bottom of the sternum is called the xiphoid process.  It can become quite tender (hypersensitive), spontaneously or following chest trauma. CT scanning of this structure can sometimes reveal abnormalities, some of which can be relieved by injections or by surgery.

The following is taken from a case report of a young man with chest and abdominal pain.  Here is the reference should you doctor be interested.


Episodic abdominal and chest pain in a young adult.
Migliore M. Signorelli M.
JAMA. 307(16):1746-7, 2012 Apr 25.
[Case Reports. Journal Article]
UI: 22535859
Authors Full Name
Migliore, Marcello. Signorelli, Maria.


Diagnosis
Hypersensitive xiphoid syndrome (so-called xiphodynia)
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What to Do Next
C. Perform xiphoidectomy
The key clinical feature in this case is making the diagnosis in a young patient with chest and abdominal pain of unknown origin. The key to making the diagnosis of hypersensitive xiphoid syndrome is the reproduction of pain when the tender part of the xiphoid is subjected to very moderate hand pressure.
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Comment
The word xiphodynia comes from the Greek xiphos for sword (the xiphoid process) and odyne for physical pain, often of an acute and sudden nature. First described in 1712, xiphodynia is a rare syndrome capable of producing myriad symptoms that can mimic several common thoracic and abdominal diseases. Common symptoms of xiphodynia may include cardiac chest pain; pain radiating into the back, neck, shoulders, arms, and chest wall; epigastric pain; nausea; vomiting; and diarrhea. Although Lipkin et al 1 found the syndrome present in about 2% of the population of a general hospital ward and stated that xiphodynia is “far more common than is generally appreciated,” no data are available on the incidence or prevalence of xiphodynia.
The diagnosis of xiphodynia is mainly clinical. Careful examination of the xiphoid should be part of a routine examination of any patient presenting with chest and abdominal pain of unknown origin. A simple provocative test, moderate pressure on the xiphoid process, may uncover a symptomatic xiphoid process and establish the diagnosis of xiphodynia. In some circumstances the prominence of the xiphoid process under the skin is evident,2 but in others the cause of xiphodynia remains unknown.

Differential diagnosis includes a variety of conditions, such as esophagitis, angina, cholecystitis, pleuritic chest pain, and inflammation of the condral cartilage. Frequently, despite extensive investigations, no definitive diagnosis can be established. The presence of refractory and recurrent pain may be erroneously treated with analgesics and psychotropic drugs.
Patients with xiphodynia are usually treated with analgesics, an elastic rib belt,3 topical heat and cold, and a course of ultrasound and laser,4 but conservative physical therapies may not be effective. However, local injection with an anesthetic-steroid combination may provide symptomatic relief.5 In the few reported patients for whom medical treatment has failed, xiphoidectomy provides resolution of symptoms.2 4 Ambulatory esophageal pH and pressure monitoring, to rule out possible pathologic gastroesophageal reflux, should not be necessary with a proper physical examination. The decision to perform a xiphoidectomy in this case was supported by the persistence of symptoms after injections of cortisone and ketoprofen.
2 Comments
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4851983_tn?1360102764
Thank you for your response, but my doctor said that this problem I have been having is to high to be something to do with my xiphoid. He did blood work on my calcium levels and stuff and it all apparently came back normal. So yet again I am stuck.
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