Sternal Foramen Research Articles

Anatomical variations of the sternum: sternal foramen and variant xiphoid morphology in dried adult human sternum in Ethiopia.

Background: The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information about the sternal foramen and variant xiphoid morphology in Ethiopia. Two extremely interesting and unusual variations of the sternal foramen are also discussed. Methods: This observational study was carried out using dried adult human sternum obtained from skeletal remains samples brought for medicolegal examination over a period of 4 years. A total of 94 dried adult human sternums (66 males (70.2%) and 28 females (29.8%)) were obtained with an age range of 21 to 57 years and a mean age at death of 38.383 ± 11.3480 years. Dried human sternum specimens were morphologically examined, and morphometric parameters were recorded and photographed. Results: A sternal foramen was found in 18 specimens (19.1%); 17 were male and one was female. A single sternal foramen was observed in 83.3% (n=15/18) of the sternal bodies and 11.1% (n=2/18) of the xiphoid processes (both males). In addition, a double sternal foramen was observed in a single male specimen on the mesosternum and xiphoid process. The most common sternal foramen site was at the fifth costochondral junction level. The xiphoid process was present in 77 samples and ended as a single process in 83.1% (n=64/77) of samples. In 15.6% (n=12/77) of the samples, the xiphoid process was bifurcated and trifurcated in a single male (1.3%) specimen. Conclusions: The sternal foramen and variation in xiphoid morphology are common anatomical variations in Ethiopia. The findings of the current study highlight the necessity of strict precautionary measures during sternal procedures in this study population. In addition, such incidental findings during radiologic and autopsy procedures should be properly evaluated to avoid misdiagnosis and misinterpretation of such findings as traumatic or pathologic conditions.

Morphometric and morphological study of most common sternal entity: sternal foramen

Morphometric and morphological study of most common sternal entity: sternal foramen

Prevalence and morphometry of sternal and xiphoid foramen: a meta-analysis on 16,666 subjects

PurposeSternal foramen is a perforation of the sternum that can be a source of misdiagnosis during radiographic imaging or life-threatening perforations during bone marrow sampling. The aim of this study was to conduct a meta-analysis on the prevalence, morphometrics, and location of foramen in the sternal body and xiphoid process, describe morphometric features of this phenomenon, and thus verify its clinical importance. Moreover, our secondary outcome was to compare effectiveness of various imaging methods in diagnosis of the sternal or xiphoid foramen.MethodsA comprehensive search was conducted on major scientific databases to identify studies containing relevant information. Data on foramen’s prevalence, location, morphometrics, and accompanying findings were extracted and pooled into a meta-analysis using MetaXL 5.0.ResultsThirty-five studies (n = 16,666 subjects) were included. The overall pooled prevalence of a foramen in the sternal body and/or a xiphoid process was 8.9% (95% CI 6.5–11.7) and it equaled 6.5% (95% CI 5.6–7.6) for sternal body alone and 2.9% (95% CI 0.5–6.9) for the xiphoid process. The foramen was more prevalent in males than in females (12.2% vs. 6.8%). The prevalence of sternal foramen was higher in South American [13.9% (95% CI 11.2–16.9)] and African [13.6% (95% CI 9.7–18.0)] studies compared to North American [6.2% (95% CI 5.0–7.5)] and European populations [8.6% (95% CI 3.1–16.3)]. Mean transverse and vertical diameter of foramen equaled 4.7 mm (95% CI 3.8–5.5), and 5.6 mm (95% CI 4.2–6.9), respectively.ConclusionOur analysis proves that the sternal foramina are structures of significant prevalence and size. Any physician should keep them in mind when performing punctures in this area.

Anatomical variants identified on chest computed tomography of 1000+ COVID-19 patients from an open-access dataset.

Chest computed tomography (CT) has been the preferred imaging modality during the pandemic owing to its sensitivity in detecting COVID‐19 infections. Recently, a large number of COVID‐19 imaging datasets have been deposited in public databases, leading to rapid advances in COVID‐19 research. However, the application of these datasets beyond COVID‐19‐related research has been little explored. The authors believe that they could be used in anatomical research to elucidate the link between anatomy and disease and to study disease‐related alterations to normal anatomy. Therefore, the present study was designed to investigate the prevalence of six well‐known anatomical variants in the thorax using open‐access CT images obtained from over 1000 Iranian COVID‐19 patients aged between 6 and 89 years (60.9% male and 39.1% female). In brief, we found that the azygos lobe, tracheal bronchus, and cardiac bronchus were present in 0.8%, 0.2%, and 0% of the patients, respectively. Variations of the sternum, including sternal foramen, episternal ossicles, and sternalis muscle, were observed in 9.6%, 2.9%, and 1.5%, respectively. We believe anatomists could benefit from using open‐access datasets as raw materials for research because these datasets are freely accessible and are abundant, though further research is needed to evaluate the uses of other datasets from different body regions and imaging modalities. Radiologists should also be aware of these common anatomical variants when examining lung CTs, especially since the use of this imaging modality has increased during the pandemic.

Sternal foramen- Incidence and medico-legal importance

Sternum foramen may be misinterpreted as acquired lesions such as gunshot wound, fracture, lytic lesions, etc. Sternal foramen leaves the lung, heart and large vessels unprotected while performing invasive procedures such as bone marrow aspiration, acupuncture leading to life-threatening complications such as pneumothorax and cardiac tamponade. From a medicolegal perspective, identifying the morphological anomalies or variations of xiphoid process aid in the individualization process by serving as points of similarity when their occurrence has been recorded antemortem. In addition, their antemortem records in the form of previous x rays make important data for skeletonized remains to be identified.The present study was carried using sternal bones removed during autopsy on a total of 350 cases above the age of 30 years and has established aincidence of 6.57% for sternal foramen.Forensic pathologists should be meticulous enough to rule out errors in determining the nature and cause of death in worrying cases as sternal foramen is highly likely to be confused with gun-shot wounds or traumatic antemortem injury.

High prevalence of sternal foramina in indigenous Bolivians compared to Midwest Americans and indigenous North Americans (sternal foramina in indigenous Bolivians).

The sternal foramen, usually an asymptomatic osteological defect, can lead to catastrophic consequences if not recognized prior to certain medical procedures. This study reports the prevalence of a sternal foramen in two South Amerindian populations compared with other published populations. We evaluated the presence of sternal foramina using thoracic computed tomography scans of 1334 (48% female) participants from two indigenous populations of Bolivia (n = 900 Tsimane, 434 Moseten). The prevalence of sternal foramina was compared to two U.S. populations of similar sex/age distribution (n = 572 Midwest Americans, 131 self-identified Native North Americans) via similar CT scans. A sternal foramen was significantly more common in the two Bolivian populations (prevalence ranging from 12.8 to 13.4%), compared to 4.4-5.1% in the two U.S. groups, consistent with prior estimates in studies from industrialized populations. Males had higher frequency of a sternal foramen compared to females in each of the four groups (OR = 1.904, 95% CI: 1.418-2.568, p < 0.001). Age was not associated with sternal foramen presence. These data show both a higher rate of sternal foramina in the South Amerindian populations versus comparator populations in North America and the highest rate of any studied living population. Although it is not possible to determine from our data the relative contribution of genetics versus early life or environmental causes to the higher rates of sternal foramen, we note that small prior studies have likewise demonstrated a higher prevalence in lower income countries. Further determination of the contributing factors warrants greater investigation and research.

Sternal Variation: Anatomical-Forensic Analysis

Background&#x0D; The aim of this study was to analyze the extent and uniqueness of anatomical variations of the sternum bone, to assess its applicability for forensic analysis, especially for individual human identification.&#x0D; Methods and Findings&#x0D; Evaluations involved 501 computer tomography scans performed at the Medical Radiology Center, Manaus city, Amazonas, Brazil, and 427 skeletons belonging to the Collection of Identified Human Skeletons of the Center for Studies in Forensic Anthropology (CEAF), of the University of Pernambuco (UPE), Pernambuco, Brazil. Forms of morphological variations were evaluated, including the presence of foramina, fissures, and incomplete total or partial fusions, as well as forms of xiphoid process termination, and the presence of surgical sutures. Overall, summing computed tomographic images and skeletons, the sternal foramen was present in some 23% of samples, with a greater proportion in males (14%), while in females the frequency was 8.6%.&#x0D; Conclusions&#x0D; The qualitative analysis of the sternum bone is simple to apply and represents an important potential source of information in a human identification process.

Morphology and Morphomertry of Sternal Foramen and Variations in Xiphoid Process in Human dry Sternum in Jammu Region

Morphology and Morphomertry of Sternal Foramen and Variations in Xiphoid Process in Human dry Sternum in Jammu Region

Topographic evaluation of sternal foramen patients with thoracic computed tomography

In our study, we aimed to determine the topographic analysis of sternal foramen cases incidentally detected in patients underwent thoracic computed tomography. Patients aged 18 and over who were admitted to the thoracic surgery outpatient clinic for various reasons and underwent thoracic computed tomography (CT) between January 1, 2018 and January 1, 2019 were evaluated retrospectively. Thoracic CT scans of all patients with sternal foramen were evaluated by applying 3D bone configuration to evaluate foramina in the sternum and ribs. The data obtained were analyzed statistically by SPSS (Statistical Package for Social Sciences Version 21.0). Nine hundred and twelve patients were evaluated and sternal foramen prevalence was found to be 8.44% in our study. Of the 68 patients included in the study, 48 were male and 20 were female. The sternal foramen was localized in the corpus in 66.2% of the patients, whereas it was localized in xiphoid in 33.8%. Nine patients had scoliosis deformity and three patients had foramen in the rib. Sternal foramen is a more common defect than thought, and should be kept in mind in clinical practice to prevent complications.

A COMPREHENSIVE STUDY OF STERNAL FORAMEN IN DRY STERNUM

Introduction: Congenital defects during the development of sternum give rise to sternal foramen. These defects are due to incomplete fusion of sternebrae. Serious life-threatening complications can occur during sternal puncture for bone marrow biopsy. Therefore, knowledge of the presence of sternal foramen is important to prevent these life-threatening complications. Our aim was to observe the incidence, location, number and shape of the sternal foramen in dry sterna. Material &amp; Methods: The present study was conducted in Department of Anatomy, Subharti Medical College, Meerut in 100 dry sterna. Various types of sternal variations were observed and documented. Results: In our study, 10% of the sterna had a sternal foramen. Single sternal foramen was present in 8 specimens (8%). Double foramina were present in 2 bones (2%). Conclusion: Sternal foramen are not uncommon. Knowledge of these variations are important for radiologists and surgeons during bone marrow biopsy.

Multidetector computed tomography (MDCT) estimation of prevalence and anatomic characteristics of the sternal body foramen in the population of central Serbia

Background/Aim. The most frequent form of sternal defects is a single foramen, usually located at the distal half of the sternal body, with prevalence that varies among different ethnic populations. Clinical importance of these defects arises from various diagnostic and therapeutic sternal treatments and close location of heart, lungs and other vital organs of the chest cavity. The aim of this study was to determine the prevalence and morphometric characteristics of the sternal midline foramen in the population of central Serbia. Methods. The multidetector computed tomography (MDCT) chest images of 422 patients of both genders were analyzed. The radiological imaging was performed on 64- slice MDCT scanner (Aquilion 64, Toshiba, Japan). All scans were performed in the axial plane, with subsequent multiplanar reconstruction (MPR). Due to the angulation of the sternal body coronal curved-planar, the images were obtained in order to show the whole length of the sternum and the vertical diameter of the sternal foramen. The measurements were done using the commercially available software (Imaging Software ver. 4.1.14.0, Vital-Images). Results. The solitary foramen, located in the distal segment of the sternal body, was detected in 24 patients, representing 5.9% of the observed population with slightly higher prevalence in males. The average size of foramen was 3.9 ? 4.2 mm. The mean distance from the skin was 12.7 ? 3.3 mm, the distance from skin to pericardium was on average 37.3 ? 8.2 mm, while the average distance from skin to pleura was 25 ? 5.9 mm. The average depth of foramen 8.7 ? 2 mm, while the mean distance from the posterior surface of foramen to pericardium was 12.7 ? 9.1 mm. Conclusion. The results presented in this paper confirmed the prevalence of 5.9% regarding the midline sternal foramen in the observed population. Serious complications of the sternal puncture could be prevented by prior MDCT imaging.

Evaluation of the morphological characteristic and sex differences of sternum by multi-detector computed tomography

Sternum is one of the skeleton parts which have frequently congenital anomalies and variations are commonly used by researchers in determining sex. We evaluated the morphological characteristics and sex-related changes of the sternum in adult individuals using multidetector computed tomography in our study. Two hundred adults (103 female and 97 male) aged between 18 and 87 years were evaluated. Utilising the morphological characteristics of the sternum based on the multislice images; length, width and the thickness of manubrium, length, width and the thickness of corpus sterni, total length of sternum, sternal angle, sternal index (SI), length of the xiphoid process, the thickness of xiphoid process, the number of indents of xiphoid process were measured and a total of 20 parameters were evaluated by adding age, height and weight to these variables. The mean length of the manubrium, the length of corpus sterni, the length of total sternum, SI, sternal angle were found in females 46.7 ± 5.1, 86.6 ± 9.7, 133.1 ± 1.1, 54.47 ± 10.0 and 163.75 ± 5.79; in males 51.2 ± 6,102.4 ± 13.3, 154.1 ± 13.1, 50.11 ± 10.02 and 162.21 ± 6.17, respectively. We found that Hyrtl's Law and SI did not provide adequate accuracy for sex determination in our patients. It has been detected that the length of the manubrium alone is not helpful for individual samples. Total length of the sternum was found to be more reliable than the length of the manubrium and the length of corpus sterni. We determined sternal cleft and sternal foramen as 0.5% and 3.5%, respectively. We suggest that the morphometric standards cannot be universally applied and can demonstrate individual differences. The standard rules must be implemented for every population.

Possible XOR fallacy – Case report of combined foramen sternale with an osseous sternal knife stab injury

Abstract This case report details a sternal finding that first was reported as penetrating knife stab wound. It was one in a series of 24 otherwise relatively superficial skin stab wounds allegedly performed by a single assailant within the scope of a single attack. The effort required to penetrate the sternum with a knife appears to be considerably higher than to inflict relatively superficial skin and soft tissue penetration. This initially raised suspicion of another person contributing to the attack, or, a different weapon being used. After reviewing the clinical CT scans, we identified the combination of a preexisting sternal foramen with a marginal fracture and concluded that the sternal “penetration” was in keeping with the depth of the other 23 stab wounds. None of the injuries were lethal, the victim survived the attack. Assuming that a knife penetration fracture of a sternum and a foramen sternale are mutually exclusive constitutes an exclusive-OR fallacy (XOR fallacy).

The costal skeleton of the Regourdou 1 Neandertal

The morphology and size of the Neandertal thorax is a subject of growing interest due to its link to general aspects of body size and shape, including physiological aspects related to bioenergetics and activity budgets. However, the number of well-preserved adult Neandertal costal remains is still low. The recent finding of new additional costal remains from the Regourdou 1 (R1) skeleton has rendered this skeleton as one of the most complete Neandertal costal skeletons with a minimum of 18 ribs represented, five of which are complete or virtually complete. Here we describe for the first time all the rib remains from R1 and compare them to a large modern Euroamerican male sample as well as to other published Neandertal individuals. The costal skeleton of this individual shows significant metric and morphological differences from our modern human male comparative sample. The perceived differences include: dorsoventrally large 1st and 2nd ribs, 3rd ribs with a very closed dorsal curvature and large maximum diameters at the posterior angle, a large tubercle-iliocostal line distance in the 4th rib, thick shafts at the dorsal end of its 6th ribs, thick mid-shafts of the 8th ribs, large articular tubercles at the 9th ribs, and thick shafts of the 11th and 12th ribs. Here we also describe a new mesosternal fragment: the left lateral half of sternebral segments 4 and 5. This portion reveals that the mesosternum of R1 had a sternal foramen in its inferiormost preserved sternal segment and supports previous estimation of the total length of this mesosternum.The new costal remains from R1 support the view that Neandertals, when compared with modern humans, show a significantly different thorax, consistent with differences found in other anatomical regions such as the vertebral column and pelvis.

A Comprehensive Review of the Sternal Foramina and its Clinical Significance.

A sternal foramen (SF), which arises from the incomplete fusion of the cartilaginous neonatal sternum, is a relatively common anatomical variation found in 2.5% to 13.8 % of all individuals. SFs are usually located at the lower third of the sternal body and their average diameter is 6.5 mm. An SF is subclinical; however, its close proximity to the thoracic organs, i.e., the heart and lungs, entails a risk of serious complications from blinded sternal interventions. Moreover, its presence can lead to misinterpretation of radiological and postmortem findings. The SF is ignored by many physicians and non-physician healthcare providers who must understand its clinical significance in order to optimize patient care. Our aim in this review is to highlight the potential clinical consequences for SF patients, discuss recommendations for performing sternal procedures safely when this anatomical variation is present, and preclude radiological and pathological misinterpretations so that patient care can be improved.

Anatomical variations of the sternal angle and anomalies of adult human sterna from the Galloway osteological collection at Makerere University Anatomy Department.

Anatomical variations of the sternal angle and anomalies of the sternum are unique happenings of major clinical significance. It is known that misplaced sternal angles may lead to inaccurate counting of ribs and create challenges with intercostal nerve blocks and needle thoracostomies. Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. These sternal variations and anomalies are rarely reported among Africans. The aim of this study was to determine the anatomical variations of the sternal angle and anomalies of the sternum among adult dry human sterna at the Galloway osteological collection, Makerere University, Uganda. This was a descriptive cross sectional study in which quantitative and qualitative data were collected. The study examined 85 adult human sterna at the Department of Anatomy, Makerere University. Univariate and bivariate analyses were done using SPSS 21.0 for Windows. Over 40% (36/85) of the specimens had variations in size, location and fusion of the sternal angle. There was no significant difference in the mean size of the sternal angle in males at 163.4 ± 6.7o compared with 165.0 ± 6.4o in females (p = 0.481). Of the 85 specimens examined, only 21 (24.7%) had a xiphoid process. The most frequent sternal anomalies were bifid xiphoid process 42.9% (9/21) and sternal foramen 12.9% (11/85). Sternal variations and anomalies are prevalent in the Galloway osteological collection and there is need for increased awareness of these findings as they may determine the accuracy of clinical and other procedures in the thoracic region.

Morphological approach of the sternal foramen: an anatomic study and a short review of the literature.

The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

Sternal Development and Variations and Anomalies in Patients With Microtia: Evaluation Using 3-Dimensional Computed Tomography.

The objectives of this study were to evaluate sternal development and variations in patients with microtia and to identify the incidence of congenital sternal anomalies and then to investigate the interaction between microtia and sternal anomalies. A total of 212 consecutive patients received a preoperative 3-dimensional chest computed tomography. A retrospective study was performed with the clinical and imaging data from November 2014 to July 2015. Descriptive statistics, analysis of variance, Spearman analysis, χ test, and Fisher χ test were performed for statistics analysis. We evaluated the ossification centers and developmental variations in the manubrium and body, as well as the xiphoid process, manubriosternal and sternoxiphoidal fusion, and sternal anomalies. Significant variations were observed from person to person. Sternal foramen was detected in 6 male patients (2.8%). All foramina were located in the inferior part of the body. Sternal cleft was observed in 4 cases (1.9%), of which 2 were accompanied by a foramen in the distal part of the sternum. The development of the different components of the sternum is a process with wide variation among patients with microtia. A different distribution of mesosternal types I to II among our population age range was found, and the incidence of sternal foramina was lower in patients with microtia.

Frequency of sternal variations in living individuals.

To evaluate the variations of the sternum and provide the prevalence of sternal foramen and its anatomical relationships. In this retrospective study, 544 subjects ranging in age from 18 to 95years were evaluated. Sternal variations, prevalence of sternal foramen and its anatomical relationships to mediastinal structures were examined with the axial, sagittal and coronal reformat images of the patients who underwent thoracic computerized tomography. In 500 subjects, following sternal variations were found: sternal sclerotic band in 120 (24%), sternal cleft in 3 (0.6%), sternal foramen in 26 (5.2%), focal cortical notch and defect in 44 (8.8%) patients. The manubriosternal fusion was partial in 65 (13%) patients and complete in 112 (22.4%) patients. The sternoxiphoid fusion was partial in 201 (40.2%) and complete in 153 (30.6%) patients. There was no xiphoid process in 9 patients (1.8%; 29-51years; mean age 38years). Xiphoidal ending types were as follows: single-ended 361 (72.2%), double-ended 125 (25%), and triple-ended xiphoid 5 (1%) patients. The sternal foramen was adjacent to the lung in 13 (2.6%), to the pericardium of heart in 3 (0.6%), and to mediastinal fat in 10 (2%) patients. The sternum is a very critical anatomic structure of the anterior chest wall with several variations that can be confused with pathologic conditions. Radiologists' familiarity with these variations is important for better radiologic evaluation in making differential diagnosis.

An Anatomic Abnormality: Double Sternal Foramina

Abstract: Sternal foraminas are developmental defects of the sternum. The incidence of sternal foramen is about 4.5% of population. They can be found usually coincidentally by radiological or postmortem examinations. In this case report, I represent an 84 years old woman with pulmonary contusion after blunt trauma who has double hole in her sternum detected by radiological examinations. Introduction: The sternum is a flat shape bone which is located in the middle of anterior thorax. It has three parts including manubrium, body and xiphoid cartilage [1]. Embryological development of sternum starts from sternal bars of ventrolateral body wall untiLthe mid-line and bar fusion finishes with the formation of xiphoid [2]. Sternal foramen (or perforated sternum) is a developmental defect and a result of the incomplete fusion of the sternal bar in the middle. The rate of sternal foramen is 4.5% (range 4.3-6.7%) of the population and usually located on inferior sternal body. Also it can be located on xiphoid part. Case Report: An 84 year old woman was admitted to thoracic surgery department with chest pain caused by thoracic blunt trauma. Diffuse pulmonary contusion and two sternal foraminas as a measurement of 7.5 mm at upper and 5 mm at lower detected by Thorax CT scan and 3D reconstruction (Figures 1-3). Pulmonary rehabilitation and analgesia therapy applied. The patient got discharged after 4 days. Discussion: Variation and anomalies of sternum is common. These malformations and anomalies are detected coincidentally by radiological examinations and postmortem. Any failure in the embryogenic process causes sternal anomalies, such as fissures or foramen. The incidence of sternal foramen evaluated as 4.3% - 6.6%-6.7% in different studies [3-5]. Others reported that developmental variations of sternum includes branched xiphoid process, V shaped bifurcation, sternum bifidum, synchondrosis sternii (incomplete ossification of the sternum), anomalies in the shape of the sternum (wedge shaped or asymmetrical bone), sternum gallinaceum and sternal foramen. Cooper detected sternal foramina in 6.7% in autopsy population that were usually solitary and located in the body of the sternum. They also detected a foramen in the manubrium. Also Moore detected 6.6% sternal foramina in an autopsy population. Yekeler evaluated the frequency of sternal foramens by MDCT in 4.5% of 1000 patient. The size of sternal foramina ranged between 2 and 16 mm in these case series [3-5] and in our case the upper foramen was 7.5 mm and lower was 5 mm. They were both located in the body of sternum. Patients with sternal foramen have the risk of spontaneous pneumothorax or pericardium tamponade during sternal biopsy or acupuncture [6]. As conclusion sternal foramen is the most common variation of sternum and mostly symptomless. It has to be kept in mind because of the serious complications after sternum biopsy and acupuncture.