Pemberton's sign
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
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 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]
References
- ↑ Pemberton, HS (1946). "Sign of submerged goitre". Lancet. 248: 509. doi:10.1016/s0140-6736(46)91790-4.
- ↑ Wallace, C; Siminoski K (1996). "The Pemberton sign". Ann Intern Med. 125: 568–569. doi:10.7326/0003-4819-125-7-199610010-00006.
- ↑ Pemberton, HS (1946). "Sign of submerged goitre". Lancet. 248: 509. doi:10.1016/s0140-6736(46)91790-4.
- ↑ Basaria, S; Salvatori R (2004). "Pemberton's sign". New England Journal of Medicine. 350: 1338. doi:10.1056/nejmicm990287.
- ↑ 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.
- ↑ 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.
- ↑ 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.