Trifid and ventrally curved xiphoid process with two sternal foramina

In this report, we present the case of a 56-year-old man with an asymptomatic, ventrally curved, trifid xiphoid process with two foramina found incidentally during a CT screening. The objective of this report is to advance the knowledge and recognition of such variations and to discuss the clinical relevance. The xiphoid process was trifid with two xiphoid foramina, one above the other, between the middle and right processes. The right process was longest (approximately 4 cm) and the middle process, the shortest (approximately 2 cm). The upper xiphoid foramen was larger (approximately 0.5 cm) than the lower one (approximately 0.3 cm). No additional musculoskeletal variations were observed on imaging. In summary, this constellation of distinctive variations of the xiphoid process in a single individual provide an opportunity to further discuss the development of the sternum, associated anatomical variations, and potential clinical ramifications from such variations in hopes of advancing knowledge and recognition of such anomalies for clinicians.