Broadbent’s sign is characterized by visible retraction of the left posterior chest wall near the 11th and 12th ribs during systole. This clinical finding is associated with extensive adhesive pericarditis, in which the pericardium adheres to surrounding tissues, restricting cardiac motion and transmitting it to the back.

Pathophysiology

In adhesive pericarditis, the normally smooth, flexible pericardium becomes fibrotic and adherent to the thoracic wall and diaphragm. During ventricular systole, the restricted heart motion causes localized posterior chest wall retraction over the lower ribs. Tangential inspection of the back allows detection of subtle movements that correspond to the cardiac cycle.

Examination technique

Patient positioning

• Have the patient sit upright or slightly leaning forward to expose the lower posterior thorax.

• Stand at the patient’s right side for optimal visualization.

Inspection

• Position a strong light tangentially so that it casts shadows across the skin and muscles of the posterior chest wall.

• Observe the 11th and 12th rib regions for retraction or inward movement during each cardiac cycle.

Auscultation

• Place a stethoscope over the precordium to correlate chest wall movement with ventricular systole.

• Note timing, intensity, and symmetry of the retraction.

Clinical utility

• Indicator of adhesive pericarditis: Supports suspicion when corroborated with other signs such as pericardial knock or muffled heart sounds.

• Noninvasive bedside clue: Detectable without imaging, though confirmation requires echocardiography or CT.

• Adjunct to history: Patients often report dyspnea, fatigue, or chest discomfort due to restricted cardiac motion.

Differential Diagnosis

Diagnostic approach

• Echocardiography: Detects pericardial thickening, adhesions, and restricted motion.

• CT/MRI: Provides structural detail of pericardial fibrosis and calcifications.

• Chest X-ray: May reveal abnormal cardiac silhouette or pericardial calcification.

• Cardiac catheterization: Assesses hemodynamic consequences if constriction is suspected.

Management

• Address underlying pericardial disease:

  • Pericardiectomy may be indicated for severe adhesive or constrictive pericarditis.

  • Symptomatic management includes diuretics for fluid overload.

• Monitor hemodynamics: Particularly for signs of heart failure or restricted cardiac filling.

Pediatric considerations

• Rare in children, usually following viral pericarditis or cardiac surgery.

• Imaging is essential for diagnosis and surgical planning.

Geriatric considerations

• Older adults may present with chronic pericardial fibrosis or post-surgical adhesions.

• Posterior chest wall retraction may be subtle due to kyphosis or increased thoracic wall thickness.

Patient counseling

• Explain that visible chest wall movements reflect changes in the heart-pericardium interaction.

• Discuss further evaluation, including echocardiography, CT, or MRI.

• Emphasize monitoring for symptoms like dyspnea, fatigue, and peripheral edema.

Conclusion

Broadbent’s sign is a valuable clinical indicator of adhesive pericarditis, providing a visible, noninvasive clue to posterior pericardial adhesion. While not diagnostic alone, it enhances bedside assessment and supports further imaging and intervention planning.

References

1. Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia: Elsevier; 2022.

2. McCance KL, Huether SE. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. St. Louis: Mosby Elsevier; 2021.

3. Butany J, et al. Cardiovascular Pathology. 5th ed. London: Elsevier; 2018.

4. Cameron JL. Current Surgical Therapy. 13th ed. Philadelphia: Elsevier; 2021.