Dahl's Sign

A 76-year-old woman was admitted to the hospital with shortness of breath. She had tachypnea and was breathing through pursed lips. The patient had a long history of advanced COPD. Symmetric, slanting regions of hyperpigmentation were noted on both thighs. A 76-year-old woman was admitted to the hospital with shortness of breath. She had tachypnea and was breathing through pursed lips. The patient had a long history of advanced chronic obstructive pulmonary disease (COPD), with a forced expiratory volume in 1 second of 21% of the predicted value. The pulmonary examination showed inspiratory retraction of the intercostal muscles and the suprasternal notch, along with diffuse, polyphonic expiratory wheezing with a prolonged expiratory phase. Symmetric, slanting regions of hyperpigmentation were noted on both thighs, a finding consistent with Dahl's sign, also known as Thinker's sign. Described in 1963 in a patient . . .