Berry Sign & Pemberton Sign | Signs in Thyroid Swelling
💎 Buy my Premium ENT Notes
Instant access to 270+ high-yield ENT notes, plus updates during your access period.
🇮🇳 For Indian Students
· To buy all my notes, click here💡 This post is a free outline of my YouTube video. Get my full handwritten notes using the links above.
Berry Sign & Pemberton Sign
Two classical clinical signs are associated with thyroid swellings. In this post, we will discuss:
- Berry Sign
- Pemberton Sign
Berry Sign
📌 Type of Sign
👉 Clinical Sign elicited by Palpation during neck examination.
🔍 What is the Sign?
Berry Sign refers to the absence of carotid artery pulsation on the affected side, in a patient with a thyroid swelling.
Where do you palpate for carotid artery pulsation?
Seen In
| Condition | Reason for Absent Pulsation |
|---|---|
| Large benign thyroid swelling | Carotid sheath and its contents displaced posteriorly |
| Malignant thyroid swelling | Carotid sheath infiltrated and encased |
👨⚕️ Eponym
Named after Sir James Berry, who described this sign as an indicator of thyroid malignancy with invasion.
Pemberton Sign
📌 Type of Sign
👉 Clinical Sign
A provocative bedside test, elicited during neck or thoracic inlet examination.
🩺 How is it Elicited?
1- The patient is asked to raise both arms straight up beside the ears
2- The position is held for 30 to 60 seconds
🔍 What is the Sign?
A positive sign is the development of the following on raising both arms above the head:
✅ Facial congestion or flushing
✅ Neck vein distension
✅ Dyspnea
✅ Stridor
✅ Syncope, in severe cases
Seen In
1- Retrosternal goiter (Most classical association)
2- Intrathoracic goiter
3- Mass involving the thoracic inlet, such as a mediastinal mass, lymphoma or thymoma, obstructing the superior vena cava
4- Large cervical goiter extending downwards (occasionally)
What is the mechanism behind Pemberton sign?
👨⚕️ Eponym
Named after Dr. Hugh Spear Pemberton, who described this maneuver as a marker of thoracic inlet obstruction due to a substernal goiter.
Which vessel is compressed in Pemberton sign?
⚠️ Important MCQ Traps
❌ Pemberton sign is not a test for thyroid function. It is a test for mechanical obstruction at the thoracic inlet.
❌ Pemberton sign is not a sign of carotid body tumor. It classically points towards a retrosternal goiter.
⭐ High Yield Rapid Revision Table
| Sign | Elicited By | Finding | Seen In |
|---|---|---|---|
| Berry Sign | Palpation of the neck | Absent carotid pulsation on the affected side | Large benign thyroid swelling, Malignant thyroid swelling |
| Pemberton Sign | Raising both arms above the head for 30 to 60 seconds | Facial flushing, neck vein distension, dyspnea, stridor | Retrosternal goiter, Intrathoracic goiter, Thoracic inlet mass |
🧠 Viva Pearls
- Berry sign is the absence of carotid artery pulsation on the affected side in a thyroid swelling.
- In benign thyroid swelling, the carotid sheath is displaced; in malignant swelling, it is infiltrated and encased.
- Berry sign is named after Sir James Berry.
- Pemberton sign is elicited by raising both arms above the head for 30 to 60 seconds.
- Pemberton sign is most classically seen in retrosternal goiter.
- Pemberton sign is a test for mechanical obstruction at the thoracic inlet, not for thyroid function.
📝 All topics and questions from this post are explained in detail in my Premium ENT Notes, which are designed for clinical understanding and exam success.
Residency is hard enough. Studying for it shouldn't be 😊
💎 Buy my Premium ENT Notes
Instant access to 270+ high-yield ENT notes, plus updates during your access period.
🇮🇳 For Indian Students
· To buy all my notes, click here