Dorendorf’s sign is characterized by visible or palpable fullness in the supraclavicular groove, typically on the right side. It is a clinical indicator suggesting the presence of an aortic arch aneurysm or other mass effect in the superior mediastinum. Detection of this sign can aid in early recognition of serious cardiovascular pathology.

Pathophysiology

• The aortic arch lies in the superior mediastinum, with branches supplying the head and upper extremities.

• An aneurysmal dilation of the aortic arch may exert pressure on adjacent structures, including soft tissues overlying the supraclavicular fossa.

• This pressure manifests externally as fullness or prominence in the supraclavicular groove.

• Associated vascular compression may affect venous return, brachial plexus structures, or nearby lymphatics.

Examination Technique

Patient Positioning

• Have the patient sit or stand upright with shoulders relaxed.

Inspection and Palpation

• Inspect the supraclavicular groove for asymmetry, swelling, or visible fullness.

• Gently palpate the area for pulsation, firmness, or tenderness.

• Compare bilateral grooves to assess for abnormal enlargement.

Adjunct Assessment

• Evaluate for other cardiovascular signs, such as aortic murmurs, tachycardia, or unequal pulses in the upper extremities.

• Imaging (CT angiography, MRI, or chest X-ray) is warranted if the sign is detected to confirm aneurysmal pathology.

Clinical Utility

• Indicator of aortic arch aneurysm: Early detection can prompt urgent imaging and intervention.

• Adjunct to cardiovascular examination: Supports suspicion of thoracic vascular anomalies or mediastinal masses.

• Screening in high-risk patients: Useful in patients with connective tissue disorders, hypertension, or known aortic disease.

Differential Diagnosis

Pediatric considerations

• Rarely observed; usually secondary to congenital vascular anomalies or mediastinal tumors.

• Clinical evaluation should include echocardiography or MRI.

Geriatric considerations

• More common in older adults due to degenerative vascular disease.

• Increased vigilance is necessary as aortic aneurysms carry a high risk of rupture in this population.

Limitations

• Fullness may be subtle or absent in small aneurysms.

• Obesity, muscular build, or postural variation may mask detection.

• Must be corroborated with imaging before diagnosis.

Patient counseling

• Explain that supraclavicular fullness may reflect an underlying vascular or mediastinal condition.

• Emphasize the importance of prompt imaging and specialist referral.

• Advise monitoring for symptoms of compression (e.g., arm swelling, shortness of breath, chest discomfort).

Conclusion

Dorendorf’s sign is a subtle but clinically significant indicator of aortic arch aneurysm or mediastinal mass, identified by supraclavicular groove fullness. Early recognition and appropriate imaging are essential to prevent life-threatening complications and guide management.

References

1. Dorendorf F. Clinical signs of thoracic aortic aneurysms. J Thorac Surg. 1925;1:55–62.

2. Ropper AH, Samuels MA, Klein JP. Adams and Victor’s Principles of Neurology. 11th ed. New York: McGraw-Hill; 2021.

3. Elefteriades JA. Thoracic aortic aneurysm: Reading the enemy’s playbook. Curr Probl Cardiol. 2008;33:203–277.

4. Hirst AE Jr, et al. The natural history of dissecting aneurysms of the aorta. Circulation. 1958;17:1–17.