Sternal Swelling, Mass and Lumps Over the Breastbone

Sternal Swelling and Mass

The sternum or breastbone is the central bone at the front of the chest to which the clavicle (collarbone) and ribs attach. It is an elongated flat bone made up of three parts – manubrium (uppermost part), body of the sternum (longest part in the middle) and the xiphoid process (short pointed part at the bottom). Most of the sternum that can be felt in detail over the skin on the chest wall especially in a thin person.

The sternum is not a smooth bone – there notches at the top (suprasternal notch) and facets on the sides for the clavicle and ribs to attach to, it also has several transverse ridges on the sternal body. The xiphoid process with its pointed end may at times be felt as a small lump at the bottom of the sternum. Overall however, the sternum sits somewhat flush with the rest of the chest wall.

Sometimes there may be swelling in or over the sternum or isolated lumps (masses) that can be felt or can even be seen over the sternum. These abnormalities need to be investigated as it may be a clinical sign of certain underlying diseases.

Other Symptoms

In most cases a sternal swelling or mass is not due to any abnormality. Most people become very conscious of the otherwise normal surface anatomy of the sternum usually after an injury or when there is pain. Nevertheless, a sternal swelling or mass should be investigated by a medical practitioner to exclude some of the causes discussed below.

Sternal swelling or a mass may also be accompanied by other symptoms such as :

  • Breastbone pain
  • Tenderness
  • Redness of the skin on the central chest wall
  • Warmth of the overlying skin
  • Difficulty breathing due to pain with inspiration in particular.

The absence of these symptoms does not mean that any swelling or lump on or over the sternum is not due to any serious cause. However, when there is one of more of these other symptoms that accompany a sternal swelling or mass then immediate medical attention should be sought.

Causes of Sternal Swelling

Injury

The sternum is covered by subcutaneous tissue and skin as part of the anterior chest wall. In addition muscles and its tendons lying next to the sternum as well as sheets of connective tissue known as fascia all contribute to the layers of tissue over the sternum. In most instances it is inflammation of these overlying layers that is more likely to be responsible for sternal swelling. The inflammation is largely acute and resolves after a short period of time unless there is repetitive injury.

More severe injury typically with a motor vehicle collision may cause a fracture of the sternum. This leads to swelling over the fracture site. In some instances where an injury does not fracture the bone, it can cause inflammation of the sternum. However, even in these case of injury without a fracture it is the swelling of the overlying tissue that is more likely to be visible and palpable.

Infection

  • Sternal osteomyelitis is an uncommon infection of the breastbone which may arise following an injury to the sternal area. Less commonly it can spread from an infection in the chest cavity, specifically the mediastinum, or spread from a distant site through the bloodstream or lymphatic system.
  • Mumps is an infection primarily of the salivary glands caused by the mumps virus. In children with mumps, there may be swelling over the sternum.
  • Cellulitis is an infection of the subcutaneous tissue which may arise after an injury to the chest wall where there is a break in the skin or following surgery.

Inflammation

  • Costochondritis is inflammation of the costal cartilage that connects the rib to the sternum. It may arise with injury, repeated coughing in respiratory tract infections, other causes of strain on the costal cartilages and sometimes for unknown reasons. Costochondritis usually does not cause and noticeable swelling of the costal cartilages through the chest wall.
  • Lymphadenitis is inflammation of the lymph nodes caused by an infection or disorders like lymph node cancer (lymphoma).  The location of lymph nodes may not always lead to obvious swelling or lumps over the sternum itself.

Cancer

  • Lymphoma is cancer of the lymph node cells (lymphocytes).
  • Leukemia is cancer of the bone marrow cells that form the blood cells and lymphatic tissue.
  • Bone cancer is a malignancy of the bone, in this case the sternum. There are several types of bone cancers such as multiple myeloma and osteosarcoma.

Nutritional diseases

  • Rickets is a childhood bone disease caused by vitamin D deficiency leading to problems with bone mineralization. The bones become soft and weak. When this disease occurs in adults it is known as osteomalacia. Sternal symptoms includes costochondral beading.
  • Scurvy is a disorder with collagen synthesis due to a vitamin C deficiency. One of the symptoms of scurvy is costochondral beading where there are lumps at the  site of the costal cartilages.

Other

  • Paget’s disease of the bone is a disorder with the break down and rebuilding of the bones which is a constant process throughout life. It can lead to bony overgrowths. The sternum is not a commonly affected site.
  • Fracture callus is a temporary phase when the bone is healing following a fracture. It may sometimes present as a palpable mass of the sternum a short while after a sternal fracture. It usually resolves as the original bone contour is restored in the final phase of bone healing.

References

1. Sternal swelling. Diagnosis Pro

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  • Char

    I am a 67 year old female who has pain and swelling on the top of the sternum. It started with pain on the right collar bone and shoulder, then went to the right side of the breast bone and some around the right side of the right breast. I am scheduling a mammogram within the next day or two. Chest X-rays were done and they found my heart to be somewhat enlarged and my lungs showing low volume breathing, which I have had this problem most of my life. I was a smoker but quit 39 years ago. I have gone to an MD, two different chiropractors, and am now heading for the doctor that also prescibes thyroid medication. Is there anything I am overlooking to have checked out or what can the doctors look for now? I would so appreciate a direction and any hints would be great. Thank you ahead of time for your time and any information you can give me.

  • HI Char. There are several possibilities and your doctors will surely do what is indicated to identify the cause. A mammogram is the next logical step. You are obviously anxious and concerned but rather leave it to the professionals.

    Trying to investigate it yourself or “advise” your doctors based on what you may read off the internet can sidetrack the professionals from doing what they have an in-depth knowledge of. You should liaise with your family doctor and keep him/her update even though you may be seeing specialists in different disciplines (example the endocrinologist for your thyroid).

    In fact your family doctor will be in the best position to advise you as to what you should expect and directly communicate with your specialists about any concerns he/she has based on your medical history. Hopefully you do have a family doctor with whom you have a long relationship. Best of luck with the mammogram.

  • mac

    i am 23 years old and have knot type thing in the very bottom of my sternum.
    i used to be a smoker. have stopped for 3 months now, dont know if that helps.
    have been running and working out regularly for the past 3 months. have no health insurance, do i need to go to hospital ?

  • usakindatheart

    hi I am 18 years and still in high school, I have really large breast, so when I do athletics, all my school years, I have to wear 2-3 bras so they won’t hurt when I run.
    I found in the middle of my sternum a bump/lump that is under the skin, It has been there for about a year now, I really breast connected to my sternum is really close together, unlike my mom, and she has a good inch across her sternum with out breast tissue coming off of it. I am thinking, after all these years, I just smushed the normal skin fat together so long, that maybe it made this bump/lump?
    reading off internet has scared me to death, I do not want my breast to be cut off. My aunt has breast cancer, at 40 years, and she is now 58, she had both of her breast cut off and lymp nodes every where taken out, but she has had so many chemo treatments, she says she just wants to die now. I do not want to have cancer. i just want it to go away, but it won’t yet. I am scared, my mom says I am too young

  • Hi Mac. It is worth having checked up and may not require a hospital immediately unless you are experiencing severe pain, dizziness or difficulty breathing. Speak to your family doctor. It may just be muscular since you have been more physically active recently. It could also be a problem with your bones or the cartilage in that area but it is difficult to say for sure on an online platform. Your doctor will be able to advise you further.

  • Hi usakindatheart. There is no need to suspect breast cancer just yet so do not get worried unnecessarily. There are many other possibilities that could account for the lump. It is very difficult to say for sure through an online platform and you should therefore consult with a medical doctor for further assessment. This could be a lymph node, it could be a bony outgrowth from the sternum, it could even be a slight dislocation of the joint between the sternum and ribs, and the list goes on. Your doctor will be able to advise you accordingly.

  • Laurie

    About two months ago, i was scrubbing crayon off walls and got sore in my ribcage. i laid down that night and thought i felt a lump in my breast. i panicked and went running to Urgent Care. doc did a breast exam and said show me area of concern. i did and she said honey thats your rib. youre thin through your chest wall so you will feel it more. I was diagnosed with costochondritis. I only weigh 108 pounds at 5’6 and 38 years old. I had my yearly female exam last week and hte doc felt that rib and said lets just do an ultrasound but you have a prominent rib. i didnt have the ultrasound. i was scared to death. i asked my chiro and he felt it and said jesus, quit freaking out… you have a prominent rib in your breast and you know what, you have it on the other side too. im just thin built.

  • Hi Laurie. Yes, it can be quite prominent in people who are very thing. However, it is always advisable to be cautious and have it checked by a medical professional, as you did. Fortunately it is not causing any severe problems but monitor the area carefully especially if symptoms like pain arises or the protrusion worsens.

  • Stacy

    I noticed about a month ago swelling between the manubruim and sternal body. It is basically the size of my palm when i put my hand over it. When i touch it, it seems hard and attached to my chest wall. Part of it seems not hard but attached as well. There has been pain associated with it ive noticed. The pain radiates to my breasts as well as other parts of my chest. Im a non smoker, non drinker, dont do drugs. I work in medical field and know it could be a number of things; however, my mind tends to go one place. I didnt injure myself either. Cancer does run rapid in my family as well. It is noticable to others as well. The picture i attached was taken 4 weeks ago. As you can see whatever it is is sticking out.

  • alex

    I have a painful hard lump on my sternum. It’s hurts especially when I bend down, not sure what it is.

  • cparsons

    I am experiencing some pain and swelling about an inch or two below my sternum. It is incredibly tender to the touch and is causing minor discomfort while breathing….I am experiencing some discomfort but mainly it is VERY swollen. I just lost 30lbs and read somewhere else that this can be your xiphoid process. I am a little scared about it, as it isn’t going away.

  • Hi Alex. This could be a bony outgrowth, or even a swollen lymph node, or some other problem with the chest wall. There is no way of saying for sure through an online platform. Speak to your doctor. You may need further diagnostic investigation before a diagnosis can be confirmed.

  • Hi cparsons. It could be due to a number of different conditions. Given your recent weight loss and the area where you are experiencing the pain, gallstones is one of the conditions that you need to consider as a possible cause. Gallstones are one of the possible complications of rapid weight loss. However, it is difficult to say for sure through an online platform. You should speak to your doctor as soon as possible.

  • cparsons

    thank you for your response! I went in and apparently it is a severe case of costochondritis!

  • Hi Cparsons. Glad that they found the cause of your pain.

  • samantha

    Hello my name is Samantha I have had this lump which is located under my collar bone above my breast towards my right breast. It been there a little less than a year, it is tender to touch but no other pain that I’ve noticed. It was smaller when I had found it and since then grown slightly. I am 21 years old and I have 3 kids. I do have state insurance just no primary and I don’t know how to go about getting it checked out. Breast cancer and just certain cancers in general run high in my family. So I’m quite concerned.

  • Hi Samantha. We have to advise that you see a medical doctor as soon as possible. Given your family history of breast cancer, it is imperative that you have it assessed. It may not be as serious as cancer but there is no way of knowing for sure without further investigation. One of the concerns here is that this is an enlarged lymph node. While enlarged lymph nodes can occur with infections and other diseases it may also arise with breast cancer. As you can see these are largely “what if’s” and without a proper diagnosis it will be difficult to say what your next step should be.

  • Kevin Felvus

    My name is Kevin and for about a month I have had swelling on my sternum and some days It hurts when I breath and hurts on a daily basis was just curious on what it could be??

  • Hi Kevin. We cannot diagnose you through an online platform but you should have this checked. Given the swelling, it could very well be a problem with the chest wall but there is always the concern of it being due to one of the vital organs in the chest cavity. The pain may be one of the first symptoms and if you leave this unattended it could progress further. Please consult with your doctor as soon as possible.

  • Ailee

    I’m 20 years old. I had a car accident 6 months ago, but still can feel suprasternal mass measures 2×2 cm . It’s not painful now and when I had chest x-ray after the accident there was no fracture. What should I do?