Bilateral fusion of first rib with sternum

Inlet of thorax is bounded by the manubrium in front, costal cartilage, first rib on both side and the first thoracic vertebra behind. A specimen of sternum fused with manubrium and xiphisternum and bilateral fusion of first rib to the manubrium was observed. The total length of the sternum was 17.14 cm. A sternal foramen of 6.77 x 3.47 mm was observed in the xiphoid process. The sternum was convex with maximum anterior convexity of 16.2 mm. It usually presents along with clavicular hyperostosis and is considered a part of SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis). This fused bony complex can cause restriction of chest wall movement and decreased pulmonary function. Thus dermatologists faced with patients presenting with pustulous and acne form skin lesions must be aware of both SAPHO syndrome and its effect on the sternocostal joints.