Revising the Exclusivity of Pemberton’s Sign: A Case Report
American Journal of Internal Medicine
Volume 2, Issue 3, May 2014, Pages: 41-43
Received: Apr. 12, 2014; Accepted: Apr. 24, 2014; Published: Apr. 30, 2014
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Authors
Philip W. Tipton, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Jeremy J. Blanchard, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Will P. Guider, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Jessica J. Keel, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Allison D. Locke, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Franchesca N. Robichaud, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
Adam Price, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
William L. Joyner, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
John K. Smith, Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA
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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.
Keywords
Permberton’s Sign, Lymphadenopathy, Restrictive Cardiomyopathy, Constrictive Pericarditis, Geriatrics, Amyloidosis
To cite this article
Philip W. Tipton, Jeremy J. Blanchard, Will P. Guider, Jessica J. Keel, Allison D. Locke, Franchesca N. Robichaud, Adam Price, William L. Joyner, John K. Smith, Revising the Exclusivity of Pemberton’s Sign: A Case Report, American Journal of Internal Medicine. Vol. 2, No. 3, 2014, pp. 41-43. doi: 10.11648/j.ajim.20140203.11
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