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Costoxiphoid ligaments

The costoxiphoid ligaments are fibrous bands that extend from the cartilages of the 6th and 7th ribs to the xiphoid process of the sternum. They form part of the anterior thoracic wall support system, helping to stabilize the xiphoid process and reinforce the anterior abdominal wall at the midline. These ligaments contribute to the attachment of fibers from the rectus abdominis and diaphragm, integrating thoracic and abdominal musculature. They are clinically significant during chest or upper abdominal surgery, as they mark the lower boundary of the sternum and may calcify with age.

Synonyms

  • Sternocostal-xiphoid ligaments

  • Xiphocostal ligaments

  • Costal-xiphoid ligaments

Function

  • Anchor the xiphoid process to the 6th and 7th costal cartilages

  • Provide structural support to the lower anterior thoracic cage

  • Serve as attachment reinforcement for rectus abdominis and diaphragm fibers

  • Contribute to thoracic wall stability and integration of respiratory and abdominal movements

MRI Appearance

T1-weighted images:

  • Appear as low-signal fibrous bands extending from the xiphoid process to costal cartilages

  • Surrounded by intermediate signal muscle and hyperintense fat, providing contrast

  • Calcified portions appear as signal voids

T2-weighted images:

  • Appear as low-signal structures, distinguishable against hyperintense surrounding fat and soft tissues

  • Inflammation or injury may appear as focal hyperintensity along the ligament

STIR (Short Tau Inversion Recovery):

  • Ligaments remain low signal, but surrounding edema, strain, or inflammatory changes appear hyperintense

  • Useful for detecting trauma, postoperative changes, or costal cartilage inflammation

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal ligaments show minimal or no enhancement

  • Pathological changes (inflammation, tumor infiltration) may show focal enhancement

CT Appearance

Non-contrast CT:

  • Ligaments are usually not well defined, seen as thin soft tissue density bands from costal cartilages to the xiphoid process

  • Calcifications (common with aging) appear as hyperdense streaks

Contrast-enhanced CT (CECT):

  • Ligaments themselves do not enhance significantly

  • Provides excellent visualization of the xiphoid, sternum, costal cartilages, and associated calcifications

  • Useful in evaluating chest wall trauma, inflammatory changes, or tumors extending into the anterior thoracic wall

MRI image

Costoxiphoid ligaments anatomy MRI coronal image -img-00000-00000

CT image

Costoxiphoid ligaments anatomy CT AXIAL image -img-00000-00000

MRI image

Costoxiphoid ligament coronal mri image-img-00000-00000

MRI image

Costoxiphoid ligament mri axial