American Journal of Internal Medicine

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Revising the Exclusivity of Pemberton’s Sign: A Case Report

Received: 12 April 2014    Accepted: 24 April 2014    Published: 30 April 2014
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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.

DOI 10.11648/j.ajim.20140203.11
Published in American Journal of Internal Medicine (Volume 2, Issue 3, May 2014)
Page(s) 41-43
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Permberton’s Sign, Lymphadenopathy, Restrictive Cardiomyopathy, Constrictive Pericarditis, Geriatrics, Amyloidosis

References
[1] Wallace, C. and Siminoski, K. The Pemberton sign. Ann Intern Med 1996, 125:568-569.
[2] Pemberton, H.S. Sign of submerged goitre. Lancet 1946, 251:509.
[3] Basaria, S. and Salvatori, R. Pemberton’s sign. N Engl J Med 2004, 350:1338.
[4] Mehta, A., Mehta, M., and Jain, A.C. Constrictive pericarditis. Clin Cardiol 1999, 22:334-344.
[5] Kushwaha, S.S., Fallon, J.T., and Fuster, V. Restrictive cardiomyopathy. N Engl J Med 1997, 336:267-276.
[6] Sing, V., Fishman, J.E., and Alfonso, C.E. Primary systemic amyloidosis presenting as constrictive pericardidits. Cardiology 2011, 118:251-255.
[7] Guan, J., Mishra, S., Falk, R.H., and Liao, R. Current perspectives on cardiac amyloidosis. Am J Physiol Heart Circ Physiol 2012, 302:544-552.
[8] Takeshita, K., Yamada, S., and Sato, N. An unusual case of mediastinal lymphadenopathy caused by amyloidosis. Intern Med 2000, 39:839-842.
[9] Chow, B.J., McKim, D.A., Shennib, H. et al. Superior vena cava obstruction secondary to mediastinal lymphadenopathy in a patient with cystic fibrosis. Chest 1997, 112:1438-1441.
[10] Tekinbas, C., Erol, M.M., Ozsu, S. et al. Giant mass due to Castleman’s disease causing superior vena cava syndrome. Thorac Cardiovasc Surg 2008, 56:303-305.
[11] Park, M., Choi, J.W., Park, H.J. et al. Hemophagocytic lymphohistiocytosis can mimic the superior vena cava syndrome. J Pediatr Hematol Oncol 2012, 34:152-154.
[12] Ling, L.H., Oh, J.K., Schaff, H.V. et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardectomy. Circulation 1999, 100:1380-1386.
[13] Leya, F.S., Arab, D., Joyal, D. et al. The efficacy of brain natriuretic peptide levels in differentiating constrictive pericarditis from restrictive cardiomyopathy. J Am Coll Cardiol 2005, 45:1900-1902.
[14] Hirota, Y., Kohriyama, T., Hayashi, T. et al. Idiopathic restrictive cardiomyopathy: differences of left ventricular relaxation and diastolic wave forms from constrictive pericarditis. Am J Cardiol 1983, 52:421-423.
Author Information
  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

  • Department of Internal Medicine, J.H. Quillen College of Medicine East Tennessee State University, Johnson City, TN, USA

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  • APA Style

    Philip W. Tipton, Jeremy J. Blanchard, Will P. Guider, Jessica J. Keel, Allison D. Locke, et al. (2014). Revising the Exclusivity of Pemberton’s Sign: A Case Report. American Journal of Internal Medicine, 2(3), 41-43. https://doi.org/10.11648/j.ajim.20140203.11

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    ACS Style

    Philip W. Tipton; Jeremy J. Blanchard; Will P. Guider; Jessica J. Keel; Allison D. Locke, et al. Revising the Exclusivity of Pemberton’s Sign: A Case Report. Am. J. Intern. Med. 2014, 2(3), 41-43. doi: 10.11648/j.ajim.20140203.11

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    AMA Style

    Philip W. Tipton, Jeremy J. Blanchard, Will P. Guider, Jessica J. Keel, Allison D. Locke, et al. Revising the Exclusivity of Pemberton’s Sign: A Case Report. Am J Intern Med. 2014;2(3):41-43. doi: 10.11648/j.ajim.20140203.11

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  • @article{10.11648/j.ajim.20140203.11,
      author = {Philip W. Tipton and Jeremy J. Blanchard and Will P. Guider and Jessica J. Keel and Allison D. Locke and Franchesca N. Robichaud and Adam Price and William L. Joyner and John K. Smith},
      title = {Revising the Exclusivity of Pemberton’s Sign: A Case Report},
      journal = {American Journal of Internal Medicine},
      volume = {2},
      number = {3},
      pages = {41-43},
      doi = {10.11648/j.ajim.20140203.11},
      url = {https://doi.org/10.11648/j.ajim.20140203.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajim.20140203.11},
      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.},
     year = {2014}
    }
    

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    T1  - Revising the Exclusivity of Pemberton’s Sign: A Case Report
    AU  - Philip W. Tipton
    AU  - Jeremy J. Blanchard
    AU  - Will P. Guider
    AU  - Jessica J. Keel
    AU  - Allison D. Locke
    AU  - Franchesca N. Robichaud
    AU  - Adam Price
    AU  - William L. Joyner
    AU  - John K. Smith
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    DO  - 10.11648/j.ajim.20140203.11
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
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    EP  - 43
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    AB  - 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.
    VL  - 2
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    ER  - 

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