Superior vena cava obstruction

What it is

SVC compression syndrome is external compression of the superior vena cava, and at the bedside it is demonstrated by Pemberton's sign.

How it presents

The picture is an elderly patient with a long-standing smoking history who comes with chronic cough, hemoptysis and constitutional symptoms, and in whom facial swelling and plethora are observed on bilateral limb elevation. That last finding is the clinical sign demonstrated, Pemberton's sign, and the clinical impression it gives is SVC compression syndrome.

For Pemberton's sign, ask the patient to raise the hands above, then you will notice that the patient becomes red. Large retrosternal goiters can cause venous distention over the neck and difficulty breathing, especially when the arms are raised.