Postoperative exostosis of the xiphoid process: a contraindication for precordial thump

A 79-year-old man was admitted for aortic valve replacement 10 years after coronary surgery. The computed tomography (CT) scan showed a 5—6-cm-long bony structure originating from the distal sternum with its tip directed towards the right ventricle (Fig. 1). The structure was resected (Fig. 2) and histopathological examination revealed an exostosis. Fig. 1. 3D CT scan showing impingement of the right ventricle by the exostosis of the xiphoid process. Fig. 2. Distal part of sternum and exostosis (white) after resection. Histo-pathological evaluation reveals bone tissue.