Pemberton's sign
Pemberton's sign was named after Dr. Hugh Pemberton, who characterized it in 1946.[1]
The Pemberton maneuver is a physical examination tool used to demonstrate the presence of latent pressure in the thoracic inlet.[2] The maneuver is achieved by having the patient elevate both arms until they 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.[3]
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,[4] the maneuver is potentially useful in any patient with adenopathy, tumor, or fibrosis involving the mediastinum. SVC has been observed as a result of diffuse mediastinal lymphadenopathy of various pathologies such as cystic fibrosis [5] and Castleman’s disease.[6] 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.[7] More recently, Tipton et al. described a patient with diffuse mediastinal lymphadenopathy due to amyloidosis. The unique configuration of enlarged lymph nodes resulted in a positive Pemberton's Sign.[8] Not surprisingly, apical lung cancers may cause a positive Pemberton's sign and a high index of suspicion should be maintained in patients with symptoms of dyspnea and facial plethora with an extensive smoking history.
References
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