A 61-year-old male presented with complaints of nausea, abdominal pain, tenderness of the xiphoid process, and the feeling of “luxation” of the sternum, as if bones were sliding over each other as he describes. He quit smoking a few years earlier, which resulted in significant weight gain. The patient was an overweight mechanic (BMI 31.7 kg/m2), who worked on buses for which he often had to carry large tires. His current complaints however prevented him from being able to work. The symptoms were thought to be gastrooesophageal reflux, and the patient was analysed by a gastroenterologist who started treatment with a proton pump inhibitor. Upper gastrointestinal endoscopy revealed, apart from a small sliding diaphragmatic hernia (3 cm), no abnormalities. Cardiac pathology was ruled out by a cardiologist. Previously taken plain radiographs of the sternum before the weight gain showed a slight anterior displacement of the xiphoid process (). At three years after the onset of his complaints a second radiograph of the sternum was obtained, which showed progression of the anterior displacement of the xiphoid process (). This progression () was thought to be due to the patients' weight gain, causing anterior displacement as a result of pressure on the xiphoid process by the panniculus. A xiphoidectomy was performed. Postoperatively the patient experienced no more pain, and he could return to work. During eighteen months of follow-up, the patient reported none of the symptoms he complained of before.
A 55-year-old male was referred to our clinic by his General Practitioner regarding complaints of his xiphoid process. Apart from routine physical examination no further analysis had been performed by the general practitioner. The patient had been overweight (BMI 30.6 kg/m2) but had recently, in an effort to live a healthier life, lost 17 kg of bodyweight, which resulted in a BMI of 25.6 kg/m2. However, since the weight loss the patient experienced a pain sensation of the xiphoid process. In his daily life, he works as a mechanic who operates heavy machinery and lifts heavy items. Ever since his weight loss he noticed that his xiphoid process was protruding and lifting items started to get bothersome and painful. In this case a computerized tomography (CT) was available (). This chest CT was made in the process of analysing his symptoms. The images show a protruding xyphoid process. A xiphoidectomy was performed. Postoperatively the patient reported no more pain and remained symptom-free during thirty months of follow-up.