Revising the Exclusivity of Pemberton’s Sign: A Case Report

Abstract

The Pemberton maneuver is a tool that may be utilized during the physical examination to demonstrate the presence of latent pressure in the thoracic inlet [1]. The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute [2]. The sign is most commonly present in patients with substernal goiters where the goiter "corks off" the thoracic inlet [3]. We describe a 67-year-old Caucasian male with a positive Pemberton's sign due to compression of the thoracic inlet by enlarged mediastinal nodes. The sign was amplified by the presence of a restrictive cardiomyopathy and constrictive pericarditis due to amyloidosis. We propose that a positive Pemberton's sign should not be used exclusively to evaluate the probability of a substernal goiter, but rather to assess the potential for vascular compression due to pathological changes in the anatomical environment of the thoracic inlet.

Pemberton Sign in a Male With Hashimoto’s Hypothyroidism

“…After a moment or so, congestion of the face, some cyanosis, and lastly distress occur, presumably from narrowing of the thoracic inlet and obstruction of the venous return (1). It has been reported mainly in patients with large goiters but also in patients with lymphomas, upper mediastinal tumors or amyloidosis (2)(3)(4)(5). Most case reports or series describe the Pemberton sign in patients with euthyroid or hyperthyroid goiters.…”