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Prepared by: ZYRINE M. SALOMON

PEMBERTON’S SIGN:

Pemberton's sign was named after Dr. Hugh Pemberton, who characterized it in 1946, The

Pemberton maneuver is a h!sica" e#amination too" used to demonstrate the resence of "atent ressure

in the thoracic in"et. The maneuver is achieved b! having the atient e"evate both arms unti" the! touch

the sides of the face. $ ositive Pemberton's sign is mar%ed b! the resence of facia" congestion and

c!anosis, as we"" as resirator! distress after aro#imate"! one minute.

 $ ositive Pemberton's sign is indicative of  suerior vena cava s!ndrome &()*, common"! the resu"t of a

mass in the mediastinum. $"though the sign is most common"! described in atients with substerna"

goiters where the goiter +cor%s off the thoracic in"et, the maneuver is otentia""! usefu" in an! atient with

adenoath!, tumor, or fibrosis invo"ving the mediastinum.

() has been observed as a resu"t of diffuse mediastina" "!mhadenoath! of various atho"ogies such

as c!stic fibrosis and )ast"eman-s disease. Par% et al.reorted en"arged cervica" "!mh nodes associated

with hemohagoc!tic "!mhohistioc!tosis as the cause of interna" ugu"ar vein comression, which

resented c"inica""! simi"ar to () s!ndrome.

 /ore recent"!, Titon et al. described a atient with diffuse mediastina" "!mhadenoath! due toam!"oidosis. The uni0ue configuration of en"arged "!mh nodes resu"ted in a ositive Pemberton's

ign. ot surrising"!, aica" "ung cancers ma! cause a ositive Pemberton's sign and a high inde# of 

susicion shou"d be maintained in atients with s!mtoms of d!snea and facia" "ethora with an

e#tensive smo%ing histor!.

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ubsterna" goiter with obstruction on in"et of nec% and, arge"! vascu"ar venous return rob"ems with nec%

certain maneuvers7 seen a"so with uer mediastina" masses and aica" "ung tumors as we"" as thoracic

aortic aneur!sm. This is manifest with arms he"d uward c"ose to the head on both side and observing

"ethora of the face and distended nec% and sca" veins. e#t comes c!anosis regiona""! with distress

worsened b! va"sa"va maneuver.

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)"inica", biochemica", and radio"ogica" assessments

T:$T/T

Treatment otions for goitre deend on the cause and the c"inica" icture and ma! inc"ude observation,

iodine su"ementation, th!ro#ine suression, thionamide medication &carbimazo"e or ro!"thiouraci"*,

radioactive iodine ab"ation and surger!.

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•  $s% the atient to "ift both arms as high as ossib"e.

•

8/19/2019 Pemberton Sign

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INSIGHT:

Pemberton's sign is used to eva"uate venous obstruction in atients with goiters. The sign is ositive

when bi"atera" arm e"evation causes facia" "ethora. 2t has been attributed to a ?cor% effect? resu"ting from

the th!roid obstructing the thoracic in"et, thereb! increasing ressure on the venous s!stem. $ccording to

some, the ?cor% effect? is caused b! the th!roid descending into the thoracic in"et during arm e"evation. $ccording to others, the obstruction is due to e"evation of the thoracic in"et against the th!roid.