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(
A
) Cervical rib with subclavian artery and middle and inferior trunks overlying following anterior scalenotomy. (
B
) Blue dash line indicating insertion of anterior scalene to cervical rib.
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All were unremarkable except for the finding of a supernumerary C8 vertebra with bilateral cervical ribs arising from this C8, with the right larger than left ( Fig. 1A, B ). 
Cervical spine computed tomography (CT) demonstrating C8 vertebrae with bilateral ribs, right larger than left. (
A
) Anterior view. (
B
) Superior view.
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This was done via a supraclavicular approach ( Fig. 2A, B ).
Portions of resected cervical rib and first rib as labeled.
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The scalenus medius insertion was therefore released off the first rib and the relevant portion of this rib was segmentally resected to decompress the costoclavicular impingement ( Fig. 3 ).