Pemberton's sign

From Wikipedia, the free encyclopedia
Jump to: navigation, search

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[edit]

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, also known as thoracic outlet syndrome, 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[edit]

  1. ^ Pemberton, HS (1946). "Sign of submerged goitre". Lancet 251: 509. 
  2. ^ Wallace, C; Siminoski K (1996). "The Pemberton sign". Ann Intern Med 125: 568–569. doi:10.7326/0003-4819-125-7-199610010-00006. 
  3. ^ Pemberton, HS (1946). "Sign of submerged goitre". Lancet 251: 509. 
  4. ^ Basaria, S; Salvatori R (2004). "Pemberton's sign". New England Journal of Medicine 350: 1338. doi:10.1056/nejmicm990287. 
  5. ^ Chow, J; McKim DA, Shennib, H et al (1997). "Superior vena cava obstruction secondary to mediastinal lymphadenopathy in a patient with cystic fibrosis". Chest 112: 1438–1441. doi:10.1378/chest.112.5.1438. 
  6. ^ Tekinbas, C; Erol MM; Ozsu S et al (2008). "Giant mass due to Castleman's disease causing superior vena cava syndrome.". Thorac Cardiovasc Surg 56: 303–305. doi:10.1055/s-2008-1038408. 
  7. ^ Park, M; Choi JW; Park HJ et al (2012). "Hemophagocytic lymphohistiocytosis can mimic the superior vena cava syndrome". J Pediatr Hematol Oncol 34: 152–154. 
  8. ^ Tipton, Philip; Blanchard JJ; Guider WP et al (April 30, 2014). "Revising the exclusivity of Pemberton's sign: A case report". American Journal of Internal Medicine 2 (3): 41–43. doi:10.11648/j.ajim.20140203.11.