A 58-year-old woman with a longstanding goitre that extends behind the sternum raises both arms above her head and develops facial plethora and stridor within thirty seconds. What does this sign indicate?

• A Thoracic outlet obstruction by a cervical rib
• B Superior vena caval obstruction by mediastinal tumour
• C Retrosternal goitre causing tracheal compression at the thoracic inlet ✓
• D Anaplastic thyroid carcinoma invading the great vessels

Explanation

This is Pemberton sign. Raising the arms pulls the goitre and surrounding soft tissues into the rigid bony ring of the thoracic inlet, compressing the trachea and obstructing venous return at the inlet. Facial congestion plus stridor localises the problem to a compressive retrosternal goitre rather than intrathoracic malignancy. Its presence is an accepted indication for thyroidectomy even in an otherwise asymptomatic multinodular goitre.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.