A 67-year-old man with a heavy smoking history presented with dyspnea for 1 month. He had lost 10% of his total body weight in the last 2 months. Physical examination showed decreased breath sounds in the right lung and pitting edema in the upper extremities, bilaterally. Elevation of his upper arms caused right supraorbital vein distention (Fig. 1), raising the suspicion of superior vena cava (SVC) syndrome. Contrast-enhanced computer tomography of the chest showed a hilar mass compressing the SVC, and a biopsy confirmed non-small cell lung cancer (Fig. 1).

Figure 1
figure 1

A (rest); B (arm raised); arrowhead: right supraorbital vein. Contrast-enhanced computer tomography of the chest; arrowhead: a hilar mass compressing the SVC.

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Pemberton’s sign is a phenomenon in which the internal jugular vein is compressed around the thoracic inlet, causing facial congestion and cyanosis with bilateral arms elevation,1 and has been reported to occur in SVC syndrome.2 The supraorbital vein drains into the internal jugular vein via the facial vein and is one of the most easily visible subcutaneous veins on the face. In the present case, Pemberton’s sign was not observed, but the right supraorbital vein became distended with elevation of the arms, elucidating the need to investigate SVC syndrome. Supraorbital vein distension with elevation of the arms may be a surrogate sign of Pemberton’s sign and a clue to suspect SVC syndrome even when Pemberton’s sign is not apparent.