Pemberton's sign in patient with substernal goiter, Pemberton's maneuver - a clinical test for latent superior vena cava syndrome caused by a substernal mass, Motion of the shoulder complex during multiplanar humeral elevation, Copyright © 2014 by the Endocrine Society, Slit2 regulates hyaluronan & cytokine synthesis in fibrocytes: Potential relevance to thyroid associated ophthalmopathy, Effects of Oral Contraception and Lifestyle Modification on Incretins and TGF-ß Superfamily Hormones in PCOS, The effect of ovarian stimulation on endothelial function- A prospective cohort study using peripheral artery tonometry, Let’s talk about sex ̶ placentas’ central role in sexually dimorphic responses to the maternal milieu, Characterizing the clinical and genetic spectrum of polycystic ovary syndrome in electronic health records, Volume 105, Issue 11, November 2020 (In Progress), The Journal of Clinical Endocrinology & Metabolism, About The Journal of Clinical Endocrinology & Metabolism, Receive exclusive offers and updates from Oxford Academic, Genotype-Dependent Brown Adipose Tissue Activation in Patients With Pheochromocytoma and Paraganglioma, Facial Plethora: Modern Technology for Quantifying an Ancient Clinical Sign and Its Use in Cushing Syndrome, A Genetic Risk Score for Thyroid Peroxidase Antibodies Associates With Clinical Thyroid Disease in Community-Based Populations. Curved planar reformation of T1W 3D SPGR images obtained in delayed post contrast phase with arms down (A) demonstrates patency of the right external jugular vein and subclavian vein confluence.
The sign is positive when bilateral arm elevation causes facial plethora. In the latter situation, as elegantly described by Blum et al (7) in 1974, the goiter descends into the thoracic inlet “much as a cork is inserted into the neck of a bottle.” During flexion, once the neck is “corked,” the patient may experience symptoms ranging from a choking sensation (8) (often nocturnal or when in a recumbent position) to inspiratory stridor, lightheadedness (7), and even syncope (7, 8). IJ, internal jugular vein; SCV, subclavian vein; EJ, external jugular veins; SVC, superior vena cava. In a short letter to The Lancet in 1946, Pemberton described a “useful sign given by a submerged goiter,” which has since been routinely performed during clinical evaluation of an enlarged thyroid. 2010 Jan-Feb;45(1):54-5. doi: 10.1016/j.regg.2009.07.009. Goiters can grow slowly, like in our patient, and extend laterally into the retroclavicular space and downward into the thoracic inlet. Because of the large goiter and a positive Pemberton's sign, concern for further growth compromising his venous system, and biopsy results of atypia of undetermined significance, bilateral thyroidectomy was recommended. Klaasen-Udding et al (5) reported seven cases with multinodular substernal goiter and right-sided superior vena caval obstruction. [The Pemberton sign] [The Pemberton sign] [The Pemberton sign] Schweiz Med Wochenschr. TSH was 1.0 μIU/mL. However, we believe that our observations about clavicular and thyroid movement during arm elevation are generalizable, given that these movements are usually demonstrable on physical examination or with neck ultrasound in cases of substernal goiter where a cervical component is present. Position was held for over 1 minute. Palpebral fissures were of normal size and symmetric. Substernal goitre, deep venous thrombosis of the arm, and Pemberton's sign. His body weight was 74.4 kg. Klaasen-Udding LM, Van Lijf JH, Ten Napel CH. Image in endocrinology. Disclosure Summary: M.R.M.S. Imaging also demonstrated retrosternal extension of the gland into the superior mediastinum with multiple venous collaterals (data not shown). Ziad F, Lacasa J, Serrano R, Aznar R, Garrapiz J. Rev Endocr Metab Disord. Within 30 seconds after she raised both arms simultaneously (Pemberton's maneuver), marked facial plethora (Pemberton's sign) developed, indicating compression of the jugular veins (Panel B). COVID-19 is an emerging, rapidly evolving situation. Venous thrombosis has been reported (5). It has been attributed to a “cork effect” resulting from the thyroid obstructing the thoracic inlet, thereby increasing pressure on … Here, we presented a 36-year-old man with a slowly growing multinodular goiter extending into both the retroclavicular area and the superior mediastinum. The authors acknowledge Jeremy A. Stormann, RTR, CT, MR, for his instrumental role in the acquisition of the magnetic resonance images.
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