Radiological appearances of the xiphoid process presenting as an upper abdominal mass

In three patients prominent, jointed xiphoid processes were confused with abdominal masses on clinical examination. In the first case, ultrasound showed acoustic shadowing at the site of the xiphoid extension. This was interpreted as a calcified abdominal mass prior to obtaining a lateral chest radiograph, which showed it to be a jointed extension from the normal xiphoid process. In the other two cases, the mass was recognized on ultrasound as a jointed xiphoid process. Awareness of this important normal variant can prevent unnecessary surgery.