Finding a hard lump in the middle of your chest can be concerning. Many such lumps are benign. This article provides general information on potential causes and when to seek medical attention. This information is a guide and not a substitute for professional medical advice.
Anatomy of the Mid-Chest
The mid-chest area contains several structures. The sternum, or breastbone, is a flat bone centrally located in the chest, protecting the heart, lungs, and major blood vessels. It has three parts: the manubrium (top), body (middle), and xiphoid process (bottom).
Costal cartilages connect the ribs to the sternum, providing elasticity for breathing. Skin and subcutaneous tissue, including fat and connective tissue, overlie these structures.
Common Benign Reasons for a Lump
A prominent xiphoid process, the small, triangular piece of cartilage or bone at the bottom of the sternum, can feel like a hard lump, especially in thinner individuals. It may cause pain if irritated (xiphodynia) and becomes more noticeable as it hardens into bone around age 40.
Inflammation of the cartilage connecting the ribs to the sternum can also cause a lump. Costochondritis involves inflammation of these costal cartilages, often causing localized chest pain without visible swelling. Tietze’s syndrome is a rarer condition with similar inflammation, but it includes noticeable swelling, pain, and tenderness. Tietze’s syndrome usually affects the second or third ribs and is more common in individuals under 40, while costochondritis often affects multiple ribs and is more common in those over 40.
Benign growths like lipomas or cysts can also appear as chest lumps. Lipomas are slow-growing, soft, fatty, non-cancerous lumps under the skin, feeling doughy and easily movable. Cysts are sac-like bumps filled with fluid, firmer and rounder than lipomas, and can become inflamed or infected, causing tenderness, redness, or warmth.
Natural variations or bony protuberances of the sternum can also feel like a hard lump. The sternum develops from segments that fuse, and these fusion points or contours can be more pronounced in some individuals, representing normal anatomical features.
Other Potential Explanations
Trauma to the chest can cause a lump. A sternal fracture (break in the breastbone) may lead to a painful lump, swelling, or deformity, especially if bone fragments are displaced. These fractures often result from direct impact, such as motor vehicle collisions. A hematoma (collection of blood) can also form after an injury and appear as a lump.
Infections, though rare, can also cause a mid-chest lump. An abscess (collection of pus) can form under the skin or deeper tissues, presenting as a tender, warm, swollen lump. Osteomyelitis, a bone infection, can affect the sternum, leading to a painful lump often accompanied by fever and other infection signs.
Rarely, a small hernia might appear in the sternal region. Hernias occur when an organ or fatty tissue protrudes through a weak spot in surrounding muscle or connective tissue.
A lump could represent a tumor, which can be benign or malignant (cancerous). These growths originate from the bone, cartilage, or soft tissues of the chest wall. While chest wall tumors are rare, about 60% are cancerous. Examples of rare malignant tumors include chondrosarcoma (forms in cartilage) or osteosarcoma (forms in bone).
Knowing When to See a Doctor
Consult a healthcare professional for any new lump that causes concern. Seek medical attention if the lump is growing rapidly or changes in size, shape, or texture; is painful, especially if the pain is severe, worsening, or persistent; or feels fixed and does not move freely under the skin.
Other concerning symptoms that should prompt a doctor’s visit include:
Fever, chills, unexplained weight loss, night sweats, or persistent fatigue.
Changes in the overlying skin, such as redness, warmth, dimpling, or ulceration.
Appearance after a significant injury or trauma.
Difficulty breathing or swallowing.
How a Diagnosis is Made
The diagnostic process begins with a medical history and physical examination. The doctor will ask about the lump’s appearance, growth, pain, and other symptoms. During the exam, the doctor assesses the lump’s size, consistency, mobility, and tenderness, also examining the surrounding chest, collarbones, and armpits.
If further investigation is needed, imaging tests may be ordered. An X-ray views bone structures for fractures or abnormalities. Ultrasound differentiates between solid and fluid-filled lumps and assesses soft tissues. For detailed views of bones, cartilage, and soft tissues, especially if a tumor is suspected, a CT scan or MRI may be performed.
Blood tests might be ordered to check for infection, inflammation, or other systemic conditions. If initial evaluations are inconclusive or there is concern about the lump’s nature, a biopsy may be recommended. A biopsy involves taking a tissue sample for laboratory analysis to determine if it is benign or malignant. This procedure is performed if other tests are inconclusive.