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Xiphoid process

The xiphoid process, also known as the xiphisternum, is the smallest and most inferior of the three components of the sternum (breastbone), forming a small, typically triangular cartilaginous projection at its distal end. Located in the epigastric region of the anterior abdominal wall, approximately at the level of the ninth to tenth thoracic vertebrae, it measures 2 to 5 cm in length and 1 to 2 cm in width, with its tip pointing inferiorly.^[1]^[2]^[3] Primarily cartilaginous at birth, the xiphoid process arises from mesodermal tissue and undergoes ossification starting in childhood or adolescence, with centers typically appearing between ages 5 and 18, though complete bony fusion with the sternal body may not occur until around age 40 or later in some individuals. It exhibits considerable anatomical variation in shape and size, appearing straight, hooked, bifid (forked), or even perforated by a foramen, which can influence its radiographic appearance and surgical relevance. Functionally, it provides attachment sites for key muscles and structures, including the rectus abdominis and transversus abdominis (contributing to the linea alba), the central tendon of the diaphragm, and occasionally the costal cartilage of the seventh rib, thereby supporting respiration, abdominal wall integrity, and trunk flexion.^[1]^[3]^[4]^[5] Clinically, the xiphoid process is notable for its vulnerability to trauma, such as fractures from blunt force or during cardiopulmonary resuscitation, potentially causing xiphodynia (pain in the region) or complications like diaphragmatic injury. Variations may lead to misdiagnosis, such as confusing a prominent or curved process for an epigastric mass or tumor on imaging. In surgery, it serves as a landmark for procedures like median sternotomy, where its attachments must be carefully detached to avoid damage to adjacent organs including the heart, lungs, and diaphragm; in symptomatic cases, xiphoidectomy (surgical removal) may be performed, as the structure is non-essential for survival.^[2]^[6]^[1]

Anatomy

Gross Anatomy

The xiphoid process, also known as the xiphisternum, is the smallest and most inferior part of the sternum, serving as its cartilaginous or bony extension. It is typically triangular or sword-shaped, with its base articulating superiorly to the distal end of the sternal body via the xiphisternal joint, a symphysis composed of fibrocartilage. In adults, it measures approximately 2 to 5 cm in length, though its dimensions can vary slightly, and it is positioned in the epigastric region at the level of the T9-T10 vertebral bodies.^[1] In the adult, the xiphoid process is primarily ossified, originating from hyaline cartilage present in youth that transitions to bone through ossification centers, though remnants of cartilage may persist in some individuals. Its surface may feature small perforations, notches, or a pitted appearance, particularly on the posterior aspect, which can influence its palpability and surgical handling. Laterally, it connects indirectly to the costal cartilages of the lower ribs through the continuity of the sternal body.^[1]^[7] The xiphoid process lies anterior to the central tendon of the diaphragm, forming a key landmark for the inferior boundary of the thoracic cavity. Posteriorly, it relates to the liver (particularly the left lobe) and portions of the stomach via the intervening diaphragm, while its position above the abdominal cavity underscores its role in delineating thoracic-abdominal transitions. Blood supply to the xiphoid process is provided by perforating branches of the internal thoracic artery, which arise along the sternum's length. Innervation is derived from the intercostal nerves, primarily segments T6 through T9, supplying sensory and vasomotor fibers to the region.^[1]^[3]^[1]

Development and Ossification

The xiphoid process arises from the ventral aspect of the lateral plate mesoderm during the sixth to seventh week of gestation, forming as the caudal extension of paired sternal bars that constitute the sternal anlage.^[4] These mesenchymal condensations migrate ventrally and fuse in the midline by the end of the seventh week, establishing the initial cartilaginous framework of the sternum, including the prospective xiphoid region.^[8] Initial chondrification of the sternal components, including the xiphoid process, occurs around the eighth week, transforming the mesenchymal tissue into hyaline cartilage that remains flexible throughout early development. During postnatal growth, the xiphoid process undergoes rapid elongation in childhood, driven by interstitial cartilage growth, while remaining predominantly cartilaginous until puberty.^[1] Ossification typically initiates between 5 and 18 years of age through one or multiple endochondral ossification centers originating inferior to the sternal body, with union to the sternal body often occurring between 15 and 29 years, progressing superiorly toward the xiphisternal junction.^[9] This process often results in incomplete fusion in many adults, preserving some mobility at the xiphisternal synchondrosis, and is modulated by hormonal factors such as estrogen, which influences the timing and extent of cartilage-to-bone conversion, with differences observed between sexes.^[10] At birth, the xiphoid process is present as a cartilaginous structure, typically palpable as a small, firm lump in the midline of the chest, becoming more defined during infancy.^[1] Full ossification generally completes by 40 to 50 years, though incomplete fusion persists in a notable proportion of individuals, potentially contributing to symptoms like localized pain if irritated. Variations in ossification patterns, which are influenced by genetic factors such as inheritance of morphological traits within families, can result in delayed or partial ossification persisting into adulthood; for example, one study found 17% of cases remaining cartilaginous past age 60.^[11]^[12]^[2]

Anatomical Variations

The xiphoid process displays considerable morphological diversity across human populations, including variations in shape, size, orientation, and presence. Common forms include the monofid (single-ended) type, which predominates, alongside bifid (forked or double-ended) structures occurring in 20-40% of individuals, trifid (triple-ended) in about 4-5%, and perforated variants with foramina in 10-30%.^[13]^[14]^[15] Elongated, curved, or deflected processes are also frequent, with ventral deflection noted in roughly 30-40% of cases on imaging, while complete absence is rarer, reported in 1-18% depending on the study population and methodology.^[13]^[14]^[16] Size metrics vary widely, with typical adult lengths ranging from 1 to 7 cm (mean 4-6 cm) and widths up to 2.5 cm, influenced by age, sex, and ossification patterns.^[6]^[2] Recent cadaveric analyses from 2024-2025 indicate that bifid processes are on average longer (e.g., 5-6 cm) and wider (e.g., 2-2.5 cm) than monofid counterparts, potentially due to differential growth during ossification.^[17] Ethnic differences exist, with higher rates of certain variations like sternal foramina in Asian populations (up to 12%) compared to African (4-5%) or European groups, though bifid prevalence shows less pronounced disparities across studies in Kenyan (15-20%) and Ethiopian cohorts (15.6%).^[18]^[16]^[19] These variations are typically asymptomatic and detected incidentally during imaging for unrelated thoracic conditions, appearing in 30-75% of cases depending on the modality and population.^[15] X-ray provides initial visualization of shape and orientation but may miss subtle features; computed tomography (CT) serves as the gold standard for precise delineation, including perforations and multi-ended forms, with multidetector CT revealing details in over 70% of scans.^[14]^[20] Ultrasound offers real-time assessment of soft tissue relations and is valuable in emergency settings for dynamic evaluation, though less sensitive for bony details than CT.^[21] Advanced imaging from 2023-2025 studies has increased detection rates compared to historical cadaveric data, uncovering variations in up to 74% of living subjects versus 20-50% in older dissections.^[15]^[16] Clinically, these anatomical differences can lead to misdiagnosis, such as interpreting a bifid or elongated process as a sternal fracture or epigastric mass on initial radiographs, potentially prompting unnecessary interventions.^[22] In surgical contexts, like cardiac or abdominal procedures involving median sternotomy, awareness of variations is essential for planning incision sites and avoiding iatrogenic injury to adjacent structures such as the pericardium or diaphragm, with perforations noted adjacent to these in 37% of cases.^[23]^[15]

Function

Muscular and Ligamentous Attachments

The xiphoid process serves as a key attachment site for several muscles involved in abdominal and thoracic mechanics. The posterior surface primarily provides attachment for the sternal slips of the diaphragm, which connect to the central tendon, providing a stable origin for this muscle's contraction during respiration.^[1] Additionally, the transversus thoracis muscle (also termed triangularis sterni) originates from the posterior aspect of the xiphoid process, contributing to the stabilization of the anterior thoracic wall.^[22] On the anterior surface, the aponeurosis of the rectus abdominis muscle attaches, facilitating the transmission of tension across the abdominal wall. Ligamentous connections reinforce the xiphoid process's integration with surrounding structures. It articulates with the distal sternal body through the xiphisternal synchondrosis, a cartilaginous joint that allows limited mobility while maintaining structural continuity.^[24] The costoxiphoid ligaments, comprising anterior and posterior bands, indirectly link the xiphoid process to the seventh costal cartilage, enhancing stability along the inferior thoracic margin; these ligaments attach to both the anterior and posterior surfaces of the process.^[25] These attachments confer biomechanical roles, particularly as an anchor for abdominal wall tension, where the rectus abdominis and diaphragm insertions enable coordinated force distribution during postural adjustments and expiration.^[1] Anatomical variations, such as bifid or perforated forms of the xiphoid process, can alter insertion points and potentially reduce attachment strength, influencing load-bearing capacity in the region.^[22] In clinical practice, these attachment zones are visualized on magnetic resonance imaging (MRI) to aid surgical mapping, particularly during median sternotomy where detachment is required to prevent damage to adjacent structures.^[1]

Role in Respiration and Movement

The xiphoid process contributes to respiration primarily through its attachment to the diaphragm, the principal muscle of inspiration. The central tendon of the diaphragm connects to the xiphoid process via two sternal slips of diaphragmatic muscle fibers, which anchor the diaphragm and facilitate its descent during inhalation.^[1] This attachment stabilizes the diaphragm, enabling efficient contraction that increases thoracic volume and draws air into the lungs.^[4] During deep breathing, the xiphoid process elevates along with the sternum, supporting the expansion of the lower thoracic cage and enhancing overall lung capacity.^[26] In terms of movement, the xiphoid process plays a supportive role in abdominal dynamics by serving as an insertion point for the rectus abdominis muscle, which aids in compressing the abdomen during activities such as forced expiration.^[1] This pull transmits forces from the abdominal wall to the thoracic structures, contributing to maneuvers like coughing and sneezing, where increased intra-abdominal pressure assists in expelling air.^[27] The process thus integrates thoracoabdominal coordination, allowing synchronized action between respiratory and core musculature for posture maintenance and dynamic stability.^[4] Biomechanically, the xiphoid process's largely cartilaginous composition, even in adults, imparts flexibility to the inferior sternum, permitting subtle mobility that complements the compliance of the thoracic cage.^[2] This elasticity reduces stress concentrations during respiratory excursions and impacts, while its connection to costal cartilages helps distribute forces across the rib cage for efficient ventilation.^[1] Ossification begins in late childhood or adolescence and may progress variably, with fusion to the sternal body often after age 40, gradually limiting this flexibility but preserving essential anchoring for diaphragmatic and abdominal functions.^[4]

Clinical Significance

Trauma and Fractures

The xiphoid process is susceptible to injury in cases of blunt chest trauma, though isolated fractures are uncommon, comprising approximately 3-4% of all sternal fractures. These injuries often occur in the context of high-energy mechanisms such as motor vehicle collisions, where rapid deceleration forces lead to avulsion or direct compression at the xiphisternal joint, particularly with seatbelt restraint across the lower chest. Falls from height or assaults can also produce similar effects through axial loading or shearing forces on the lower sternum. Such fractures are frequently associated with concomitant injuries, including rib fractures (in up to 50% of cases), pulmonary contusions, or cardiac injuries, underscoring the need for comprehensive trauma evaluation.^[28]^[29]^[30] Clinically, patients present with acute, sharp epigastric pain that may radiate to the abdomen, neck, or shoulders, exacerbated by movement, coughing, or deep breathing; localized tenderness at the xiphoid tip upon palpation is a hallmark finding. Diagnosis relies on a high index of suspicion in trauma settings, supported by imaging: a lateral chest radiograph can identify obvious fractures, while computed tomography (CT) is preferred for detecting occult or subtle xiphoid injuries and assessing for associated thoracic or abdominal damage. Ultrasonography may aid bedside evaluation in unstable patients by visualizing discontinuity or hematoma at the xiphoid site. Differential considerations include costochondritis or visceral injury, but reproduction of pain with direct pressure strongly suggests xiphoid involvement.^[31]^[29]^[32] Management of xiphoid process fractures is predominantly conservative, especially for nondisplaced or isolated cases, involving analgesia (e.g., nonsteroidal anti-inflammatory drugs or opioids as needed), respiratory support to prevent atelectasis, and activity restriction for 4-6 weeks to allow healing. Hospital observation is warranted if vital signs are unstable or significant comorbidities exist, with serial monitoring for complications such as pneumothorax, hemothorax, or chronic pain syndromes like xiphodynia. Surgical fixation, typically with plates or wires, is infrequently required but indicated for displaced fragments causing ongoing symptoms or impingement on adjacent structures; outcomes are generally favorable with low rates of nonunion.^[29]^[33]^[34]

Surgical and Diagnostic Relevance

The xiphoid process serves as a critical surgical landmark, particularly defining the inferior boundary for median sternotomy incisions in cardiac procedures such as coronary artery bypass grafting (CABG).^[1] This approach involves incising along the midline from the suprasternal notch to the xiphoid tip, allowing access to the mediastinum while minimizing disruption to surrounding structures; xiphoid-sparing variations further reduce postoperative wound complications in select cases.^[35] Additionally, it guides pericardial access during subxiphoid echocardiography, where the transducer is positioned inferior to the process to visualize cardiac structures through an acoustic window formed by the liver.^[36] In procedural applications, the subxiphoid region provides an entry point for pericardiocentesis, with the needle inserted below the xiphoid and angled toward the left shoulder to aspirate pericardial effusion safely.^[37] It also facilitates placement of laparoscopic ports, as in sleeve gastrectomy, where trocars are positioned along the subcostal margin relative to the xiphoid for optimal abdominal access.^[38] Resection via xiphoidectomy is employed for therapeutic purposes, including removal of primary tumors like chondrosarcoma originating from the process or for pain relief in refractory xiphodynia when conservative measures fail.^[39]^[40] Diagnostically, palpation of the xiphoid process locates the proper hand position for cardiopulmonary resuscitation (CPR), positioning the heel of the hand just superior to it on the lower sternum to achieve compressions of 5-6 cm depth at a rate of 100-120 per minute.^[1]^[41] The subxiphoid window enables ultrasound imaging of the abdominal aorta, with the probe placed midline below the process to assess for aneurysms by measuring diameter in longitudinal and transverse views.^[42] Variations in xiphoid morphology, such as elongation or ventral deviation, can produce CT artifacts that mimic epigastric masses or pathology, necessitating careful multiplanar reconstruction for accurate differentiation.^[22] Historically, the xiphoid process's role in surgery was first detailed in 19th-century anatomical and operative texts, with median sternotomy techniques emerging for mediastinal access around the 1890s.^[43] In modern practice, post-2020 advancements emphasize its utility in minimally invasive techniques, such as subxiphoid single-port robotic thymectomy, which reduces incision size, postoperative pain, and recovery time compared to traditional approaches.^[44] Iatrogenic complications include fractures from procedural trauma, such as during CPR compressions or rarely from pressure in intubation and endoscopy.^[1] Such injuries may contribute to unintended thoracic trauma, as explored in related contexts.

Pathological Conditions

Xiphoid syndrome, also known as xiphodynia, involves irritation of the xiphoid process leading to anterior chest pain that often mimics cardiac or gastrointestinal disorders.^[45] This condition typically presents with localized tenderness at the xiphosternal junction, radiating discomfort to the epigastrium, throat, or arms. Risk factors include anatomical variations such as anterior deflection of the xiphoid process, which may irritate surrounding tissues.^[32] Congenital anomalies of the xiphoid process, including absence or hypoplasia, are rare, occurring in less than 3% of cases based on cadaveric and imaging studies.^[46] These malformations can be isolated or associated with broader sternal defects, such as sternal clefts, where the xiphoid may fail to form properly due to incomplete fusion of sternal primordia.^[47] Similarly, hypoplasia has been linked to chest wall deformities like pectus excavatum, potentially contributing to functional impairments in thoracic mechanics, though most cases remain asymptomatic.^[48] Other pathological conditions affecting the xiphoid process include primary tumors, such as chondrosarcoma, which are exceedingly rare and account for a small fraction of chest wall malignancies.^[49] Infections like osteomyelitis can involve the xiphoid following trauma, leading to localized bone destruction and systemic symptoms if untreated.^[50] In elderly individuals, incomplete or irregular ossification of the xiphoid process may provoke chronic pain due to mechanical irritation or degenerative changes at the xiphisternal joint.^[51] Diagnosis of these conditions relies on clinical examination, with reproduction of pain upon palpation being a hallmark of xiphoid syndrome, while imaging such as MRI helps differentiate from gastrointestinal issues like reflux by identifying soft tissue inflammation or structural anomalies without visceral involvement.^[52] Management is primarily conservative, involving nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief, with local corticosteroid injections offered for persistent cases.^[53] Surgical excision of the xiphoid process is reserved for refractory symptoms or confirmed malignancy, yielding good outcomes in select patients.^[53] Recent 2024 research has highlighted how xiphoid morphological variations, including acute xiphisternal angles and soft tissue compression, correlate with higher incidence of xiphodynia, aiding in earlier identification through CT evaluation.^[54]

Comparative Anatomy

In Non-Human Mammals

In non-human mammals, the xiphoid process forms the caudal terminus of the sternum, typically consisting of a small bony or cartilaginous extension that anchors the diaphragm and ventral abdominal wall. This structure varies considerably across species, reflecting adaptations to locomotion, posture, and body size. In carnivores such as dogs and cats, the xiphoid process is elongated and often prolonged by a prominent xiphoid cartilage, which projects between the ventral costal arches to provide robust attachment for the linea alba and abdominal musculature.^[55]^[56]^[57] In herbivores like horses and sheep, the xiphoid process is generally smaller and more cartilaginous, with a flattened, heart-shaped form in equines that supports the diaphragm's muscular fibers without extensive bony ossification. Sheep exhibit a well-developed xiphoid cartilage extending caudally, which aids in stabilizing the cranial ventral abdominal wall during grazing and rumination. Rodents, such as rats, retain persistent xiphoid cartilage throughout life, making this structure a valuable model in experimental studies for cartilage biology and ossification processes, as evidenced by histological analyses showing hyaline-like cartilage composition.^[58]^[59]^[60]^[61] Non-human primates, including lemurs and rhesus monkeys, feature a prominent xiphoid process similar to that in humans, with 7-8 sternebrae and a distinct caudal extension visible on radiographs, serving as an attachment site for thoracic and abdominal muscles adapted to arboreal or quadrupedal movement. Functionally, the xiphoid process in quadrupedal mammals plays an enhanced role in locomotion by providing leverage for stronger diaphragmatic contractions during rapid breathing and abdominal bracing, differing from bipedal forms by integrating more directly with the ventral body wall for stability. In veterinary practice, the xiphoid process serves as a key surgical landmark for minimally invasive approaches to the cardiac apex and caudoventral thorax in dogs and cats, facilitating procedures like pericardiocentesis.^[62]^[63]^[57]^[64]

Evolutionary Aspects

The xiphoid process, representing the caudal extension of the sternum, originated in early tetrapods as part of a cartilaginous sternal plate that provided structural support for the pectoral girdle and facilitated the transition from aquatic to terrestrial locomotion.^[65] This sternal structure emerged alongside the evolution of limb-bearing appendages in Devonian tetrapodomorphs, serving as an anchor for ventral thoracic muscles and contributing to the stabilization of the body during weight-bearing activities on land.^[66] In synapsid lineages leading to mammals, the sternum underwent ossification, with the earliest evidence of a segmented, ossified sternum documented in Permian synapsids such as biarmosuchians around 290 million years ago, marking a key adaptation for enhanced respiratory mechanics.^[67] The xiphoid process specifically evolved to augment diaphragm attachment, with the mammalian diaphragm itself arising in the common ancestor of caseids and true mammals over 300 million years ago, well before the diversification of therian mammals around 200 million years ago, to improve ventilatory efficiency during increased metabolic demands.^[68]^[69] Adaptively, the xiphoid process exhibits variations tied to locomotor and postural shifts across mammals. In bipedal humans, its reduced size and variable morphology reflect evolutionary modifications to the thoracic cage for upright posture, minimizing ventral projections that could impede balance or abdominal organ positioning while maintaining essential attachments for the diaphragm and rectus abdominis.^[65] This reduction parallels broader sternal streamlining in hominids, as seen in fossil evidence from Australopithecus, where thoracic adaptations supported efficient bipedal gait without the extensive muscular leverage required in quadrupedal primates.^[70] Conversely, in aquatic mammals like whales, the xiphoid process integrates into a broadened, robust sternum that anchors powerful hypaxial muscles for undulatory swimming, contributing to thoracic rigidity during prolonged submersion rather than direct buoyancy control, which is primarily managed by blubber and lung compression.^[71] Such adaptations highlight how xiphoid morphology scales with locomotor ecology, with larger, more integrated forms in semi-aquatic or fully aquatic species enhancing force transmission for propulsion.^[72] Comparatively, the xiphoid process shows significant evolutionary lability, including outright loss or modification in non-mammalian tetrapods. In many reptiles, such as lizards and crocodilians, the sternum remains largely cartilaginous without a distinct ossified xiphoid extension, reflecting a reliance on flexible thoracic structures suited to sprawling gait and ectothermic metabolism.^[65] Birds, diverging from theropod dinosaurs, have repurposed the sternal caudal region into an elongated keel for flight muscle attachment, effectively integrating or reducing xiphoid-like features to optimize aerodynamics, with variability evident in flightless forms like ratites where the structure is shallower.^[73]^[74] This variability correlates with dietary and locomotor transitions; for instance, in birds, deeper keels (incorporating xiphoid elements) support high-power flight in aerial predators, while shallower forms align with terrestrial foraging in ground-dwellers, suggesting selection pressures from energy demands and habitat shifts drove these changes across archosaurian lineages.^[75] Fossil records confirm the xiphoid process's presence and conserved ossification in early Cenozoic mammals, providing snapshots of its macroevolutionary stability. In Eocene primates and pantolestids from formations like the Green River, well-preserved sterna are documented, serving similar diaphragmatic roles amid post-Cretaceous mammalian radiation.^[76] These patterns, traceable back to Triassic cynodonts, indicate that xiphoid development via multiple sternebral centers was established by the late Paleozoic, with minimal alteration across mammalian orders despite diverse locomotor ecologies. Recent genetic investigations, including those post-2023, underscore Hox genes' role in orchestrating xiphoid variation through axial patterning. Hox cluster expression, particularly Hoxa and Hoxd paralogs, regulates thoracic-caudal boundaries and sternal segmentation, with disruptions leading to anomalies like bifid or absent xiphoid processes in model organisms.^[77] Studies from 2024 highlight how Hox-mediated homeotic shifts influence vertebral and sternal formula, implying that human xiphoid malformations may stem from similar regulatory imbalances, offering insights into evolutionary constraints on thoracic diversity.^[78] This genetic framework explains observed phylogenetic variability, linking locomotor adaptations to conserved developmental modules.^[79]

Terminology

Etymology

The term "xiphoid" derives from the Ancient Greek words xiphos (ξίφος), meaning "straight sword," and eidos (εἶδος), meaning "form" or "shape," reflecting the pointed, sword-like appearance of the structure in many individuals.^[80]^[81] The Latin equivalent, processus xiphoideus, similarly emphasizes this morphology and was adopted in anatomical nomenclature to describe the inferior extension of the sternum.^[1] The term was first systematically employed in anatomical literature by the Greek physician Galen in the 2nd century AD, who referred to it as os xyphoïdes, a direct translation of the Greek xiphoeidēs osteon (ξιφοειδές ὀστοῦν), in his descriptions of skeletal anatomy.^[82] This descriptive naming was influenced by the process's frequent triangular or elongated form, which Galen and his predecessors likened to ancient weaponry. The term entered English anatomical discourse through 16th-century translations of classical texts, notably in the works of Andreas Vesalius, whose De humani corporis fabrica (1543) utilized processus xiphoideus, facilitating its adoption in Renaissance anatomy. Over time, descriptive variants such as "xiphisternum" emerged in the 18th and 19th centuries to denote its sternal attachment, but by the mid-19th century, "xiphoid process" became the standardized term in English-language anatomy texts, as seen in systematic classifications like those in Henry Gray's Anatomy (1858).^[83]

Nomenclature and Synonyms

The official Latin term for the xiphoid process, as defined in the Terminologia Anatomica (first edition 1998, updated second edition 2019), is processus xiphoideus sterni. In English anatomical literature, it is commonly referred to as the "xiphoid process" or, interchangeably, "xiphisternum."^[1]^[84] Historical synonyms include the "ensiform process," derived from its sword-like shape and used in older anatomical texts; "metasternum," referring to its position as the third segment of the sternum; and "xiphoid appendix," emphasizing its appendage-like extension from the sternal body.^[85]^[86]^[87] Regional and linguistic variations exist in non-English nomenclature, such as the French "processus xiphoïde" and the German "Schwertfortsatz" (sword extension).^[88]^[89] In veterinary anatomy, particularly for species where the structure remains largely cartilaginous, it is often termed "xiphoid cartilage" or "cartilago xiphoidea."^[59]^[55] The term processus xiphoideus was standardized in the Nomina Anatomica (also known as the Basle Nomina Anatomica or BNA), adopted by the German Anatomical Society in 1895, to promote uniformity in anatomical terminology across international contexts.^[90] In clinical and imaging reports, specifying "xiphoid" helps avoid confusion with "xiphisternum," which can refer to the xiphisternal joint (symphysis xiphosternalis) rather than the process itself.^[4] The preference for "xiphoid process" in modern clinical usage further distinguishes the bony or cartilaginous extension from the articulation.^[1]^[84]

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Traumatic fractures of the sternum – typical distribution and need for ...
Jun 27, 2025 · These were divided into 35.8% (48) manubrium fractures, 60.4% (81) fractures of the corpus sterni and 3.7% (5) fractures of the xiphoid process.
[29]
Sternal Fractures - StatPearls - NCBI Bookshelf
Jun 22, 2024 · Clinicians commonly diagnose these fractures using lateral chest radiographs or chest computed tomography scans. Sternal fractures ...
[30]
Traumatic sternal fractures: a narrative review - PMC - NIH
The leading mechanism is motor vehicle collision found in 68% of patients, followed by falls (7.9%), motorcycle injuries (7.9%), pedestrian-struck (3.4%), and ...Missing: xiphoid process prevalence
[31]
Ultrasonography of sternal fractures - PMC - NIH
This paper describes the use of clinician‐performed ultrasound to detect sternal fractures in trauma patients.
[32]
Treatment and Management of Xiphoidalgia - PMC - NIH
Aug 25, 2022 · The diagnosis of xiphodynia is primarily dependent on the physical exam, where applying pressure to the xiphoid process reproduces pain symptoms ...
[33]
Traumatic Sternal Fractures can be Safely Treated Conservatively
Conservative treatment is safe and effective for traumatic sternal fractures. Surgical treatment should be reserved for rare cases.
[34]
A decade of treating traumatic sternal fractures in a single-center ...
The most common surgical treatment is open reduction and internal fixation (ORIF) using a plate. This method is recognized as the most effective for stabilizing ...
[35]
Traumatic fractures of the sternum – typical distribution and need for ...
Jun 27, 2025 · Objective of this study is the morphologic validation of the AO-classification of the sternal bone and particularly define subgroups.
[36]
Median sternotomy - MMCTS
Aug 23, 2015 · The xiphoid is marked in the midline, and the linea alba is incised followed by digital dissection of the process from the underlying tissue of ...
[37]
Echocardiography for Emergency Physicians | Sonoguide - ACEP
Aug 18, 2020 · Obtain subxiphoid view. Palpate xiphoid process, place probe inferior with the indicator to the patient's right. Initially orient slightly ...
[38]
Pericardiocentesis - StatPearls - NCBI Bookshelf - NIH
Jan 19, 2025 · This is the most common technique, where the needle is inserted below the xiphoid process, directed toward the left shoulder. This approach ...
[39]
Laparoscopic Sleeve Gastrectomy - A SAGES Wiki Article
Next, a 5-mm trocar port is placed along the left subcostal margin between the xiphoid process and the left flank port. Another 12-mm port is placed in the ...
[40]
Novel Chest Wall Reconstruction Following Excision of an ...
Computed tomography scan demonstrated a large mass arising from the xiphoid process; biopsy confirmed a grade 1 chondrosarcoma. The mass was removed en bloc ...
[41]
xiphoidectomy for xiphodynia, a rare thoracic wall disorder - Bakens
Xiphoidectomy for xiphodynia is a safe and effective surgical procedure with good outcomes on pain relief when conservative therapy fails. Though, future ...
[42]
Part 7: Adult Basic Life Support
In adult cardiac arrest, rescuers should perform chest compressions with the patient's torso at approximately the level of the rescuer's knees. It is reasonable ...
[43]
Abdominal Aortic Aneurysm | Sonoguide - ACEP
Aug 17, 2020 · Ultrasound is an ideal method for detecting Abdominal Aortic Aneurysms (AAA) due to its accuracy, low cost, and ability to be performed at ...Missing: subxiphoid | Show results with:subxiphoid
[44]
Less invasive cardiac operations through a median sternotomy
Background. In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy.
[45]
Subxiphoid Single-Port Robotic Thymectomy Using the ... - MDPI
Three recent meta-analyses have shown that minimally invasive thymectomy achieves better cosmetic outcomes, lower postoperative complication rates, lower blood ...
[46]
Xiphodynia: A diagnostic conundrum - PMC - PubMed Central
Sep 15, 2007 · Xiphodynia is a term used to describe an 'uncommon' syndrome with a constellation of symptoms ranging from upper abdominal pain, chest pain, sometimes throat ...
[47]
A case-control study evaluating CT signs of xiphoid process ... - NIH
May 20, 2025 · This study assessed whether CT signs of the xiphoid process, such as the xiphisternal angle and soft tissue compression, are useful for diagnosing xiphodynia.
[48]
Discrete Traits of the Sternum and Ribs: A Useful Contribution to ...
Mar 28, 2013 · The sternum is composed of three parts (manubrium, body, and xiphoid process), and its many variations are visible on imaging or on dry bones.
[49]
Bifid sternum - PMC - PubMed Central - NIH
A bifid sternum is a rare congenital anomaly generally diagnosed as asymptomatic at birth ... xiphoid process, or U-shaped, with a bony bridge joining the two ...Missing: prevalence | Show results with:prevalence
[50]
Surgical Repair of Complete Congenital Sternal Cleft Associated ...
Jun 14, 2019 · Complete congenital cleft sternum associated with pectus excavatum is a rare abnormality. We report on the surgical repair of a sternal cleft ...
[51]
[PDF] A Rare Case of a Mediastinal Tumor, Located Under the Diaphragm
Nov 19, 2022 · The aim of the current study is to report a rare case of mediastinal cystic chondrosarcoma, originating from the xiphoid process of the sternum, ...
[52]
Primary Sternal Osteomyelitis caused by Staphylococcus aureus in ...
May 23, 2017 · Primary sternal osteomyelitis (PSO) is a rare condition that may develop without any contiguous focus of infection.Missing: xiphoid | Show results with:xiphoid
[53]
Sternal Pain - Different Causes - Physiopedia
Sternum pain is usually caused by problems with the muscles and bones near the sternum and not the sternum itself.
[54]
Xiphodynia | SpringerLink
May 11, 2019 · If highly concerning for tumor pathology, a computed tomography (CT) or magnetic resonance imaging (MRI) of the chest is recommended.<|control11|><|separator|>
[55]
Xiphodynia as an Unusual Cause of Chest Pain: A Case Series - PMC
Feb 7, 2023 · Previous studies showed that a xiphoidectomy is an effective surgical procedure with improvement of symptoms in 89 to 100% of patients.Missing: tumors | Show results with:tumors
[56]
Xiphoid process - vet-Anatomy - IMAIOS
The xyphoid process is the most caudal sternebra, continued by xyphoid cartilage, and serves for attachment of abdominal wall and linea alba.
[57]
Canine Anatomy - Veterian Key
Jul 8, 2016 · The sternum is relatively long and has a manubrium and xiphoid process, with a prominent xiphoid cartilage. The ribs limit overall thoracic ...
[58]
Sternal Abnormalities on Thoracic Radiographs of Dogs and Cats
Apr 2, 2023 · The most caudal last sternebra, or xiphoid process (processus xiphoideus), is flat and long, occasionally with a foramen in its caudal half.
[59]
The chest | Veterian Key
Oct 28, 2017 · The rear end of the sternum is a flattened and heart shaped cartilagenous structure known as the xiphoid process to which muscle fibres of the ...
[60]
Xiphoid cartilage - vet-Anatomy - IMAIOS
Xyphoid process and its cartilage project between the ventral parts of the costal arches and serve for attachement of abdominal wall and linea alba.
[61]
Thoracic radiographic anatomy in sheep | Tanzania Veterinary Journal
Apr 6, 2017 · The sternum was concave upward with the manubrium sterni almost vertically positioned. It consisted of manubrium sterni, xiphoid process and ...
[62]
Revisiting morphology of xiphoid process of the sternum in human
Aug 22, 2024 · The xiphoid process (XP) has both bone and cartilage. 85% of XPs have some cartilage, and are classified into four types based on ossification. ...
[63]
Radiographic thoracic anatomy of the ring-tailed... - Ovid
Differences exist in the normal radiographic thoracic anatomy of primates. ... 5) sternebrae and a xiphoid process. The cranial extremity of the manubrium ...
[64]
Topographical Anatomy of the Rhesus Monkey (Macaca mulatta)
Humans and non-human primates, such as rhesus monkeys, share a common ancestor that lived roughly 10 million years ago. As a result, remarkable anatomical and ...
[65]
Minimally Invasive Transxiphoid Approach to the Cardiac Apex and ...
Nov 30, 2012 · Transxiphoid approach is minimally invasive and provides adequate exposure for disorders of the caudoventral thoracic cavity.Missing: landmark | Show results with:landmark
[66]
Embryonic Development of the Avian Sternum and Its Morphological ...
Sep 29, 2021 · The muscles that are attached to the sternum support forelimb locomotion and aid breathing. The sternum is an attachment site for the pectoral ...
[67]
A comprehensive phylogeny and revised taxonomy of ... - Journals
Jun 26, 2024 · A comprehensive phylogeny and revised taxonomy of Diadectomorpha with a discussion on the origin of tetrapod herbivory. Jasper Ponstein.Missing: xiphoid | Show results with:xiphoid
[68]
The earliest segmental sternum in a Permian synapsid and its ...
Aug 5, 2022 · However, the sternum bridges the girdle to the axial skeleton and it is therefore connected with shifts in locomotor evolution. And it is ...Missing: variability dietary
[69]
https://pubmed.ncbi.nlm.nih.gov/20080210/
[70]
The evolutionary origin of the mammalian diaphragm - PubMed
Apr 15, 2010 · The origin and evolution of this bronchoalveolar lung into a high-performance gas-exchange organ results in a high work of breathing that cannot be achieved ...
[71]
New fossils of Australopithecus sediba reveal a nearly ... - eLife
Nov 23, 2021 · ... demonstrate that this individual was adapted to upright posture and bipedal locomotion but also had adaptations for climbing in trees.
[72]
Farewell to life on land – thoracic strength as a new indicator ... - NIH
Jul 10, 2016 · Many tetrapod taxa have secondarily shifted their habitat from land to water. Among mammals (Tetrapoda), whales and sirenians are known to have ...
[73]
Baleen Whales (Mysticetes) - ScienceDirect.com
This chapter explores the baleen or whalebone whales (Mysticeti), one of the two recent (non-fossil) cetacean suborders. Modern baleen whales differ from ...Missing: xiphoid | Show results with:xiphoid
[74]
Insight into the early evolution of the avian sternum from juvenile ...
Oct 9, 2012 · The sternum is one of the most important and characteristic skeletal elements in living birds, highly adapted for flight and showing a diverse range of ...
[75]
The relationship between sternum variation and mode of locomotion ...
Aug 19, 2021 · We show that a large sternum with a deep or cranially projected sternal keel is necessary for powered flight in modern birds.
[76]
The relationship between sternum variation and mode of locomotion ...
Aug 19, 2021 · Background: The origin of powered avian flight was a locomotor innovation that expanded the ecological potential of maniraptoran dinosaurs, ...
[77]
(PDF) A New Skeleton of Palaeosinopa didelphoides (Mammalia ...
Jul 8, 2014 · A new subadult partial skeleton of a pantolestid is reported from the late early Eocene Fossil Butte Member of the Green River Formation.
[78]
Homeotic and nonhomeotic patterns in the tetrapod vertebral formula
We uncovered mammalian homeotic patterns and found balances between distal vertebrae not anticipated by a Hox-vertebral homeotic relationship.
[79]
The Hox code responsible for the patterning of the anterior vertebrae ...
We found that Hox genes in HoxB- and HoxC-related clusters participate in regulating the morphology of the zebrafish anterior vertebrae.
[80]
Maternal SMCHD1 regulates Hox gene expression and patterning in ...
Jul 25, 2022 · Here we report that the epigenetic regulator SMCHD1 has a maternal effect on Hox gene expression and skeletal patterning.Missing: xiphoid | Show results with:xiphoid
[81]
xiphoid - Wiktionary, the free dictionary
Etymology. From Ancient Greek ξιφοειδής (xiphoeidḗs, “sword-shaped ... (anatomy) Of or relating to the xiphoid process (also called xiphisternum).English · Adjective
[82]
Xiphoid - Etymology, Origin & Meaning
From Greek xiphos "a sword," origin possibly Semitic; meaning sword-shaped or resembling a sword in anatomy, coined 1746 with suffix -oid.Missing: process | Show results with:process<|control11|><|separator|>
[83]
[PDF] Galen's Elementary Course on Bones - Europe PMC
(3) Corone is frequently used by Galen, notably for the coronoid process of the mandible. It does not refer to the likeness to a crown but to the end of the ...
[84]
Text - Vesalius: The China Root Epistle - Cambridge University Press
Close to its end it is also wide, but not thick; immediately afterward it narrows into cartilage [processus xiphoideus], not unlike the point of a sword.
[85]
https://www.elsevier.com/resources/anatomy/skeletal-system/axial-skeleton/xiphoid-process/20529
[86]
Xiphisternum | Radiology Reference Article | Radiopaedia.org
Aug 30, 2025 · The xiphisternum, also known as the xiphoid process or simply the xiphoid, is the smallest of the three parts of the sternum.
[87]
Xiphoid Process | Complete Anatomy - Elsevier
The xiphoid bone (xiphoid bone, xiphisternum or ensiform bone) is the thin, triangular, lower part of the sternum. It is located at the level of the tenth ...
[88]
Xiphoid appendix - Clinical Anatomy Associates Inc.
May 5, 2021 · UPDATED: The term [xiphoid] is Greek in origin [ξίφος] and points to the similarity [-oid] of the sternum to a short straight sword used by ...
[89]
Sternum (anatomy) – GPnotebook
Jan 1, 2018 · xiphoid process (processus xiphoideus; ensiform or xiphoid appendix; xiphisternum). xiphoid process is the smallest of the three pieces: it ...
[90]
Processus xiphoïde du sternum : anatomie et fonction - Kenhub
Aug 20, 2025 · Le processus xiphoïde, également appelé xiphisternum, est la plus petite et la plus inférieure des trois parties du sternum.Missing: German Schwertfortsatz
[91]
xiphoid process - Translation into German - examples English
Put your hands in the xiphoid process. Die Hand auf den Schwertfortsatz.Missing: xiphoïde | Show results with:xiphoïde
[92]
[PDF] Anatomical names, especially the Basle nomina anatomica ("BNA")
The purpose of this book is to help the student, teacher and clinician to become familiar with 5,000 international BNA terms and to discard upwards of 45,000 ...