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The Pemberton Sign

Clarissa Wallace, MD, FRCPC; and Kerry Siminoski, MD, FRCPC
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From the University of Alberta, Edmonton, Alberta, Canada. Requests for Reprints: Kerry Siminoski, MD, FRCPC, Endocrine Centre of Edmonton, Suite 608, 8215-112 Street, Edmonton T6G 2C8, Alberta, Canada. Current Author Addresses: Dr. Wallace: 202-301 East Columbia Street, New Westminster V3L 3W5, British Columbia, Canada. Dr. Siminoski: Endocrine Centre of Edmonton, Suite 608, 8215-112 Street, Edmonton T6G 2C8, Alberta, Canada.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(7):568-569. doi:10.7326/0003-4819-125-7-199610010-00006
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With years of continued growth, the thyroid may extend downward and enlarge within the chest, resulting in a substernal goiter. Symptoms and signs may arise from compression of the structures located within the bony confines of the thoracic inlet, including the trachea, esophagus, and vasculature [1]. The Pemberton maneuver is a physical examination method that elicits manifestations of latent increased pressure in the thoracic inlet by altering arm position to further narrow the aperture. The maneuver involves “elevat[ing] both arms until they touch the sides of the head”; if the sign is present, “after a minute or so, congestion of the face, some cyanosis, and lastly distress become apparent” [2]. To illustrate the Pemberton maneuver and emphasize its role in the physical diagnosis of substernal goiter, we describe a patient who had the Pemberton sign.

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Grahic Jump Location
Figure 1. Head and neck with arms down ( ) and arms elevated ( ).
The Pemberton sign.leftright
Grahic Jump Location




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