Abstract
In the 1920's, Hoover described a sign that could be considered a marker of severe airway obstruction. While readily recognizable at the bedside, it may easily be missed on a cursory physical examination. Hoover's sign refers to the inspiratory retraction of the lower intercostal spaces that occurs with obstructive airway disease. It results from alteration in dynamics of diaphragmatic contraction due to hyperinflation, resulting in traction on the rib margins by the flattened diaphragm. The sign is reported to have a sensitivity of 58% and specificity of 86% for detection of airway obstruction. Seen in up to 70% of patients with severe obstruction, this sign is associated with a patient's body mass index, severity of dyspnea and frequency of exacerbations. Hence the presence of the Hoover's sign may provide valuable prognostic information in patients with airway obstruction, and can serve to complement other clinical or functional tests. We present a clinical and molecular review of the Hoover's sign and explain how it could be utilized in the bedside and emergent management of airway disease.
Highlights
In the 1920's, Hoover described a sign that could be considered a marker of severe airway obstruction
Hoover's sign refers to the inspiratory retraction of the lower intercostal spaces
It results from alteration in dynamics of diaphragmatic contraction due to hyperinflation, resulting in traction on the rib margins by the flattened diaphragm
Summary
In the 1920's, Hoover described a sign that could be considered a marker of severe airway obstruction. When patients presents with an acute exacerbation of airway disease in the emergency room or in a physician's office, they are less likely to tolerate laborious radiological examinations (such as computed tomograms) and pulmonary function tests (which require intense patient participation) It is in this situation that a positive Hoover's sign, in association with other clinical parameters, blood gases or peak expiratory flow tests is likely to assist in patient triage and management in emergency settings. Hoover's sign refers to the paradoxical inspiratory retraction of the rib cage and lower intercostal interspaces (Figure 1 Panels A and B) This patient had evidence of moderate airway obstruction and elevated residual volumes (Figure 1 Panels C and D). Further studies would certainly improve insights into the pathogenesis of airway obstruction but probably would be unlikely to be done in this day and age of high technology and digital imaging
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