A 9-year-old boy presented with pectus excavatum associated with a complete congenital sternal cleft. The ends of the ribs were not palpable (Fig. 1). The defect was covered only by a layer of skin and pulsation of the heart and great vessels could be seen easily. Spiral computed tomography showed that sternum was absent but other intrathoracic structures were completely normal.

Fig. 1. Sternal cleft and pectus excavatum

Asternia is a very rare condition and may occur as an isolated entity or as part of a syndrome such as Cantrell’s pentalogy and Leiber’s syndrome. Isolated asternia is a benign malformation with a good prognosis. In this anomaly, the heart and great vessels may easily be injured by external trauma. In addition, the deformity is cosmetically unpleasant. The management of this anomaly is challenging with respect to appropriate time for surgical reconstruction.