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Pemberton's sign: explained nearly 70 years later.

Elena A De Filippis1, Amin Sabet, Maryellen R M Sun

  • 1Division of Endocrinology, Diabetes, and Metabolism (E.A.D.F., A.S., J.R.G.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215; Department of Endocrinology (E.A.D.F., J.R.G.), Harvard Vanguard Medical Associates, Boston, Massachusetts 02215; Department of Endocrinology (A.S.), Signature Healthcare, Brockton, Massachusetts 02301; and Department of Radiology (M.R.M.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215.

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Summary
This summary is machine-generated.

Pemberton's sign, indicating venous obstruction in goiter patients, is caused by clavicles compressing veins against the thyroid, not a "cork effect." This finding clarifies the mechanism behind facial plethora during arm elevation.

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Area of Science:

  • Vascular Surgery
  • Endocrinology
  • Radiology

Background:

  • Pemberton's sign is a clinical indicator of venous obstruction in patients with goiters.
  • The sign is characterized by facial plethora upon bilateral arm elevation.
  • Previous theories attributed the sign to a "cork effect" from thyroid obstruction of the thoracic inlet.

Observation:

  • A 36-year-old male with substernal goiter presented with a positive Pemberton's sign.
  • Magnetic resonance angiography (MRA) was performed with arms elevated and at rest.
  • No significant craniocaudal movement of the goiter was observed during arm elevation.

Findings:

  • MRA revealed medial and inferior movement of the clavicles during arm elevation.
  • This clavicular motion obstructed the confluence of the right external jugular and subclavian veins.
  • The mechanism was identified as clavicular compression of venous structures against the enlarged thyroid.

Implications:

  • The study refutes the