The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Pemberton’s Sign in a Patient with a Goiter

A B C

A
77-year-old man was referred to the endocrinology clinic for Yazan Abu-Shama, M.D.
the evaluation of subclinical hyperthyroidism. He had no symptoms of University Hospital of Nancy
thyrotoxicosis and no dyspnea or dysphonia that would suggest tracheal Nancy, France
compression. Physical examination revealed an enlarged thyroid with no palpable
Thomas Cuny, M.D., Ph.D.
nodules or cervical lymphadenopathy (Panel A). Pemberton’s sign — reversible
facial congestion after elevation of both arms (Panel B and video) — was noted. University Hospital of Marseille
Marseille, France
The plasma thyrotropin level was 0.2 mIU per liter (reference range, 0.4 to 4.4), thomas.cuny@ap-hm.fr
and the serum level of free thyroxine was normal. Computed tomography of the
neck revealed an enlarged thyroid that was compressing the subclavian and jugu-
lar veins (Panel C) and a patent trachea that deviated to the left (Panel C, arrow).
Pemberton’s sign is indicative of superior vena cava syndrome due to obstruction
of the thoracic inlet. The patient underwent an uncomplicated total thyroidectomy, A video showing
Pemberton’s sign
and a benign goiter was observed on pathological analysis. Thyroid hormone therapy is available at
was prescribed, and the patient was euthyroid on follow-up 6 months after surgery. NEJM.org
DOI: 10.1056/NEJMicm1712263
Copyright © 2018 Massachusetts Medical Society.

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