| Summary: | Thoracic outlet syndrome (TOS) is a group of disorders characterized by the compression of neurovascular structures at the thoracic outlet. Arterial TOS, the least common but most severe form, carries significant thromboembolic risks and has a known association with cervical ribs. Synostosis of a complete first and second rib, termed the Srb anomaly, is rare and occurs in approximately 0.2% of the population. Here, we present a unique case of a 17-year-old boy with right upper extremity claudication owing to arterial TOS from an Srb anomaly. This case emphasizes the successful management of an uncommon condition, the importance of accurate diagnosis and timely intervention.
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