Pemberton’s Sign in a Patient with a Goiter- Physical examination revealed an enlarged thyroid with no palpable nodules or cervical lymphadenopathy (Panel A). Pemberton’s sign — reversible facial congestion after elevation of both arms (Panel B and video) — was noted. The plasma thyrotropin level was 0.2 mIU per liter (reference range, 0.4 to 4.4), and the serum level of free thyroxine was normal. Computed tomography of the neck revealed an enlarged thyroid that was compressing the subclavian and jugular veins (Panel C) and a patent trachea that deviated to the left (Panel C, arrow). Pemberton’s sign is indicative of superior vena cava syndrome due to obstruction of the thoracic inlet. #clinical #photo #NEJM #Pembertons #sign #radiology #CT #goiter