Pemberton's Sign
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《新英格兰医药杂志》
A 58-year-old woman with a 20-year history of goiter presented with a two-month history of progressive dyspnea on exertion, occasional stridor, and a choking sensation while supine. She had previously been asymptomatic. Physical examination revealed a diffusely enlarged thyroid with no palpable nodules (Panel A), but the lower poles of the thyroid were not palpable. Within 30 seconds after she raised both arms simultaneously (Pemberton's maneuver), marked facial plethora (Pemberton's sign) developed, indicating compression of the jugular veins (Panel B). The patient's serum thyrotropin and free thyroxine concentrations were normal. Computed tomography of the neck revealed a large goiter extending into the anterior superior mediastinum and causing compression and deviation of the trachea (Panel C). The patient underwent thyroidectomy, and her symptoms resolved. Pathological examination revealed a multinodular goiter. Pemberton's sign is observed when the thoracic inlet rises so that it becomes filled ("plugged") by a large goiter that extends retrosternally. This phenomenon is also known as "thyroid cork."
Shehzad Basaria, M.D.
Roberto Salvatori, M.D.
Johns Hopkins University School of Medicine
Baltimore, MD 21224
Related Letters:
Pemberton's Sign
Pearce E. N., Braverman L. E., Basaria S., Salvatori R.
Extract | Full Text | PDF
N Engl J Med 2004; 351:196, Jul 8, 2004. Correspondence
Shehzad Basaria, M.D.
Roberto Salvatori, M.D.
Johns Hopkins University School of Medicine
Baltimore, MD 21224
Related Letters:
Pemberton's Sign
Pearce E. N., Braverman L. E., Basaria S., Salvatori R.
Extract | Full Text | PDF
N Engl J Med 2004; 351:196, Jul 8, 2004. Correspondence