Images in Clinical Medicine

Pemberton's Sign

Shehzad Basaria, M.D., and Roberto Salvatori, M.D.

N Engl J Med 2004; 350:1338March 25, 2004

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Article

A 58-year-old woman with a 20-year history of goiter presented with a two-month history of progressive dyspnea on exertion, occasional stridor, and a choking sensation while supine. She had previously been asymptomatic. Physical examination revealed a diffusely enlarged thyroid with no palpable nodules (Panel A), but the lower poles of the thyroid were not palpable. 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). The patient's serum thyrotropin and free thyroxine concentrations were normal. Computed tomography of the neck revealed a large goiter extending into the anterior superior mediastinum and causing compression and deviation of the trachea (Panel C). The patient underwent thyroidectomy, and her symptoms resolved. Pathological examination revealed a multinodular goiter. Pemberton's sign is observed when the thoracic inlet rises so that it becomes filled (“plugged”) by a large goiter that extends retrosternally. This phenomenon is also known as “thyroid cork.”

Shehzad Basaria, M.D.
Roberto Salvatori, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD 21224

Citing Articles (5)

Citing Articles

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   Jae Y. Kim, Wayne L. Hofstetter. (2010) Tumors of the Mediastinum and Chest Wall. Surgical Clinics of North America 90:5, 1019-1040
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   Giacomo D. Simonetti, Carmen Casaulta, Jean-Marc Vuissoz, Mario G. Bianchetti, Jean-Marc Nuoffer. (2009) Recurrent Unexplained Episodes of Facial Cyanosis and Shortness of Breath in Hunter Disease. The Journal of Pediatrics 155:1, 144-144.e1
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   2007. The Thyroid and Its Disorders. , 250-276.
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   William Li Pi Shan, Roupen Hatzakorzian, Mark Sherman, Steven B. Backman. (2006) Upper airway compromise secondary to edema in Graves’ disease. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 53:2, 183-187
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5. 5

   (2004) Pemberton's Sign. New England Journal of Medicine 351:2, 196-196
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