Abstract: Tuberculosis (TB) remains a major health problem that affects approximately 2 billion people worldwide. Only 1% to 3% of TB cases have skeletal involvement, with sternal involvement being extremely rare. We present a case report and literature review of primary sternal TB, the initial presentation in our patient mimicking a sarcoma. The patient was successfully treated with medical therapy alone, and imaging after 1 year confirmed dramatic resolution of the mass lesion. Of the estimated 70 case reports of sternal TB published between 1941 and 2006, this review includes 27 cases that met our inclusion criteria. The average age of the patients was 37.9 years, and mean duration of symptoms was 9.3 months. Erythrocyte sedimentation rate was always elevated, but white cell count was usually normal. Imaging frequently showed mass and erosion on chest x-ray and computed tomography. Definitive diagnosis was with histological and microbiological examination of the sternal tissue. Histology was obtained from either aspiration, biopsy, or directly from surgery. Most patients underwent a surgical procedure, and all but 1 patient recovered with appropriate antituberculous therapy (mean, 9.9 months). The indolent nature of the disease makes diagnosis difficult, and we propose that primary sternal TB be suspected in every patient from an endemic area that presents with a painful mass or swelling with or without systemic symptoms. Medical therapy should not be delayed in any case where there is a high clinical suspicion. In the absence of any structural complications, we suggest a trial of medical therapy alone with surgery being reserved only for refractory cases. The prognosis with appropriate treatment is excellent.