The Pemberton Sign

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.