Oliver's sign

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Synonyms and keywords: Tracheal tug sign

Overview

Oliver's sign is an abnormal downward movement of the trachea during systole that can indicate a dilation or aneurysm of the aortic arch. Oliver's sign is elicited by gently grasping the cricoid cartilage and applying upward pressure while the patient stands with his or her chin extended upward. Due to the anatomic position of the aortic arch, which overrides the left main bronchus, a downward tug of the trachea may be felt if an aneurysm is present.

Historical Perspective

The sign was first described by English military surgeon William Silver Oliver in 1878.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Aortic aneurysm
• Aortic dissection

Common Causes

• Aortic aneurysm
• Aortic dissection
• Atherosclerosis
• Cystic medial necrosis
• Marfan's syndrome
• Trauma

Causes by Organ System

Cardiovascular	Aortic dissection, aortic aneurysm, annuloaortic ectasia, aortitis, arterial tortuosity syndrome, atherosclerosis, Beals syndrome, bicuspid aortic valve, cystic medial necrosis, giant cell arteritis, HANAC syndrome, hypertension, infective endocarditis, kawasaki disease, Loeys-Dietz syndrome, MASS phenotype, polyarteritis nodosa, septic emboli, unicuspid aortic valve
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, diabetes, hyperlipidemia
Environmental	obesity, smoking
Gastroenterologic	Polycystic kidney disease
Genetic	Beals syndrome, cystic medial necrosis, HANAC syndrome, Loeys-Dietz syndrome, Marfan's syndrome, MASS phenotype, polycystic kidney disease, pseudoxanthoma elasticum, Turner syndrome, Ehlers-Danlos syndrome , Shprintzen syndrome, unicuspid aortic valve, Weill-Marchesani syndrome
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Aortitis, chagas disease, infective endocarditis, quaternary syphilis, salmonella, septic emboli, tuberculosis
Musculoskeletal/Orthopedic	Acromegaly, ankylosing spondylitis, Ehlers-Danlos syndrome, HANAC syndrome, Loeys-Dietz syndrome, Marfan's syndrome, pseudoxanthoma elasticum, relapsing polychondritis, Shprintzen syndrome, Weill-Marchesani syndrome
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Ankylosing spondylitis, Behçet disease, giant cell arteritis, Kawasaki disease, polyarteritis nodosa, scleroderma
Sexual	No underlying causes
Trauma	Chest trauma
Urologic	No underlying causes
Miscellaneous	Aging , obesity

Causes in Alphabetical Order

• Acromegaly

• Aging

• Aortic aneurysm

• Aortic dissection

• Ankylosing spondylitis

• Annuloaortic ectasia

• Aortitis

• Arterial tortuosity syndrome

• Atherosclerosis

• Beals syndrome

• Behçet disease

• Bicuspid aortic valve

• Chagas disease

• Cystic medial necrosis

• Diabetes

• Ehlers-Danlos syndrome

• Giant cell arteritis

• HANAC syndrome

• Hyperlipidemia

• Hypertension

• Infective endocarditis

• Kawasaki disease

• Loeys-Dietz syndrome

• MASS phenotype

• Marfan's syndrome

• Obesity

• Polyarteritis nodosa

• polycystic kidney disease

• Quaternary syphilis

• Relapsing polychondritis

• Salmonella

• Scleroderma

• Septic emboli

• Shprintzen syndrome

• Smoking

• Pseudoxanthoma elasticum

• Takayasu's arteritis

• Trauma

• Tuberculosis

• Turner syndrome

• Unicuspid aortic valve

• Weill-Marchesani syndrome

References

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