Xiphodynia: An easily diagnosed but frequently overlooked cause of non-cardiac chest pain

Background: Various syndromes of chest pain caused by gastro-esophageal reflux disease, inflammation or trauma to the chest wall structures have been described. These syndromes should be differentiated from serious disorders such as myocardial ischemia, pulmonary embolism, aortic dissection and pancreatitis. Only few case reports exist that describe pain in the xyphoid region (i.e. xiphodynia) that mimicked serious causes of chest pain, and lead to unnecessary, costly and sometimes invasive evaluations. Objectives: To describe a cohort of adult patients suffering from xiphodynia. Additionally, we reviewed the patient's charts for unnecessary diagnostic procedures and relate to the diagnosis and treatment of xiphodynia. Methods: An 18-month observational study of patients suffering from pain in the xyphoid region was conducted in a 40-bed medical ward at a tertiary care university hospital. Patient's charts were reviewed for evaluation, diagnostic procedures and treatment. Results: Out of 428 patients discharged with the diagnosis of non-cardiac chest pain during this period, 14 patients suffering from xiphodynia were identified. Prior to diagnosis nine patients underwent various diagnostic procedures, including cardiac catheterization. After diagnosis, eight patients were treated by injection of a combination of long-acting steroid combined with local anesthetic to the xyphoid region with achievement of immediate and long lasting relief of the pain in most cases. We stress the observation that xiphodynia is under-recognized in general practice, an observation that leads to increased patient morbidity and medical costs.