Clinical Image

Pemberton’s Sign

Neil Keshvani*, Christina Yek and David H Johnson
Department of Internal Medicine, University of Texas Southwestern Medical Center, USA

*Corresponding author: Neil Keshvani; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA


Published: 12 Sep, 2017
Cite this article as: Keshvani N, Yek C, Johnson DH. Pemberton’s Sign. Ann Clin Case Rep. 2017; 2: 1435.

Clinical Image

A 52-year-oldpreviously healthy man presented to the Emergency Department after a syncopal episode. He endorsed a history of fatigue and lightheadedness.Physical examination revealed mild neck and facial swelling (Figure 1) but was otherwise unremarkable. Upon elevating his arms above his head, he developed more noticeable facial edema and pronounced facial erythema (Figure 2). CT of the chest revealed a 6.9 x 4.7 x 5.8 cm craniocaudal mass in the right mediastinum that occluded the superior vena cava (SVC). A biopsy of the mass subsequently demonstrated metastatic renal cell carcinoma. This eponymous physical exam finding – Pemberton’s sign – was first reported by Dr. Hugh Pemberton in 1946 and is characterized by facial plethora and venous engorgement with bilateral arm elevation [1]. This phenomenon is attributed to clavicular movement causing a “nutcracker” effect that compresses major venous structures [2]. This exam finding is a clinically simple and yet underutilized maneuver that ishelpful in revealing SVC obstruction.

Figure 1

Another alt text

Figure 1
Mild neck and facial swelling.

Figure 2

Another alt text

Figure 2
Elevating his arms above his head, he developed more noticeable facial edema and pronounced facial erythema.

References

  1. Pemberton HS. Sign of submerged goitre. Lancet. 1946; 248: p509.
  2. De Fillippis EA, Sabet A, Sun MR, Garber JR. Pemberton’s sign: explained nearly 70 years later. J Clin Endocrinol Metab. 2014; 99: 1949-1954.