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The Pemberton and Maroni Signs
- Kerry Siminoski, MD; and
- Clarissa Wallace, MD
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IN RESPONSE:
Norcross and colleagues point out the vagaries of photographic reproduction. The “after” picture was taken immediately after the “before” picture, and the original slides are quite faithful to the color. During the publication process, however, the “after” picture became slightly altered in darkness and color. Nevertheless, we believe it aptly demonstrates the Pemberton sign.
The authors also question the sharp line of demarcation between the suffused skin and normal skin. The only reasonable explanation is that the affected vasculature happens to supply the skin in a distribution with a sharp line of demarcation. This same appearance can be seen in some cases of superior vena cava obstruction, such as that shown in Figure 6.39 of Epstein and colleagues' book on clinical examination [1].
Dr. Auwaerter refers to another rare, and rarely demonstrated, cutaneous finding of thyroid disease. The Maroni sign is an area of redness overlying an overactive thyroid gland. Although our patient did have subclinical hyperthyroidism, the cutaneous blood vessels in the neck are probably not the result of local effects of the thyrotoxic gland but rather of chronic vascular dilatation. Consequently, we probably should not refer to this as the Maroni sign but as a “pseudo-Maroni” sign.
Kerry Siminoski, MD
Clarissa Wallace, MD
Endocrine Centre of Edmonton; Edmonton, Alberta T6G 2C8, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
