What is this ?The Pemberton Sign

Head and neck with arms down (left) and arms elevated (right).

This is Pemberton sign positive.

• 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 .
• 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 "elevating 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".
• The Pemberton sign is an important indicator of increased pressure in the thoracic inlet.
• Pemberton sign occurs when the thoracic inlet becomes obstructed during positional changes, resulting in compression of the jugular veins.

It is a common manifestation of retrosternal goiter but may also occur with lung carcinoma, lymphoma, thymoma, or aortic aneurysms.