Pemberton's sign

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|differential = superior vena cava syndrome

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The Pemberton's sign is a physical examination tool used to demonstrate the presence of latent pressure in the thoracic inlet.{{cite journal |last=Wallace |first=C |author2=Siminoski K |date=1996 |title=The Pemberton sign |journal=Ann Intern Med |volume=125 |issue=7 |pages=568–569 |doi=10.7326/0003-4819-125-7-199610010-00006 |pmid=8815756 |s2cid=32532890}} The sign is named after Hugh Pemberton, who characterized it in 1946.{{cite journal|last=Pemberton|first=HS|title=Sign of submerged goitre|journal=Lancet|date=1946|volume=248|issue=6423|page=509|doi=10.1016/s0140-6736(46)91790-4 }}

The Pemberton maneuver is achieved by having the patient elevate both arms (usually 180 degrees anterior flexion at the shoulder) until the forearms touch the sides of the face. A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute.{{cite journal|last=Pemberton|first=HS|title=Sign of submerged goitre|journal=Lancet|date=1946|volume=248|issue=6423|page=509|doi=10.1016/s0140-6736(46)91790-4 }}

Causes

A positive Pemberton's sign is indicative of superior vena cava syndrome (SVC), commonly the result of a mass in the mediastinum. Although the sign is most commonly described in patients with substernal goiters where the goiter "corks off" the thoracic inlet,{{cite journal|last=Basaria|first=S|author2=Salvatori R|title=Pemberton's sign|journal=New England Journal of Medicine|date=2004|volume=350|issue=13|pages=1338|doi=10.1056/nejmicm990287|pmid=15044645}} the maneuver is potentially useful in any patient with adenopathy, tumor, or fibrosis involving the mediastinum. SVC syndrome has been observed as a result of diffuse mediastinal lymphadenopathy of various pathologies such as cystic fibrosis{{cite journal|last=Chow|first=J |author2=McKim DA |author3=Shennib, H|title=Superior vena cava obstruction secondary to mediastinal lymphadenopathy in a patient with cystic fibrosis|journal=Chest|date=1997|volume=112|issue=5 |pages=1438–1441|doi=10.1378/chest.112.5.1438|pmid=9367491 |display-authors=etal}} and Castleman’s disease.{{cite journal|last=Tekinbas|first=C|author2=Erol MM |author3=Ozsu S|title=Giant mass due to Castleman's disease causing superior vena cava syndrome.|journal=Thorac Cardiovasc Surg|date=2008|volume=56|issue=5|pages=303–305|doi=10.1055/s-2008-1038408|pmid=18615381|s2cid=21183690|display-authors=etal}} Park et al. reported enlarged cervical lymph nodes associated with hemophagocytic lymphohistiocytosis as the cause of internal jugular vein compression, which presented clinically similar to SVC syndrome.{{cite journal|last=Park|first=M|author2=Choi JW |author3=Park HJ|title=Hemophagocytic lymphohistiocytosis can mimic the superior vena cava syndrome|journal=J Pediatr Hematol Oncol|date=2012|volume=34|issue=4|pages=152–154|doi=10.1097/MPH.0b013e3182422a20|pmid=22395213|s2cid=22479614|display-authors=etal}}

Pemberton's sign

Causes

References

Further reading