---
title: "Berry Sign & Pemberton Sign | Signs in Thyroid Swelling"
description: "ENT notes on Berry Sign and Pemberton Sign."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/pemberton-sign-berry-sign"
categories: ["Signs, Syndromes, Triads, and Compilation Lists in ENT", "Thyroid"]
video: "https://www.youtube.com/watch?v=2nkINcNVABM"
image: "https://media.theentresident.com/og-images/pemberton-sign-berry-sign.png"
---

# Berry Sign & Pemberton Sign | Signs in Thyroid Swelling

ENT notes on Berry Sign and Pemberton Sign. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=2nkINcNVABM

## 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.

---

## About This Note

This free ENT note on Berry Sign & Pemberton Sign | Signs in Thyroid Swelling was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/pemberton-sign-berry-sign

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Signs, Syndromes, Triads, and Compilation Lists in ENT: https://www.theentresident.com/ent-notes-lectures/category/signs-syndromes-triads-lists-in-ent.md
- Thyroid: https://www.theentresident.com/ent-notes-lectures/category/thyroid.md

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