Lymph Nodes
Overview
- Examination of the supraclavicular lymph nodes is of particular importance in the gastrointestinal exam, as enlargement of Virchow's node (the left supraclavicular node) may occur due to embolisation of a GI tumour.
How to Assess
- Using the pulps of the fingers, gently palpate each of the lymph node groups within the cervical and axillary regions.
Feel For
- Size - normally <10mm
- Tenderness
- Consistency - hard (metastasis), rubbery (lymphoma), soft (reactive)
- Mobility - mobile or tethered to underlying structures
Causes of Lymphadenopathy
- Infection - bacterial, viral, fungal, protozoal
- Inflammatory disorders - lupus, rheumatoid arthritis
- Malignancy - leukaemia, lymphoma, metastasis
- Medications - allopurinol, atenolol, cephalosporins, penicillin, phenytoin
- Benign idiopathic lymphadenopathy
Cervical Lymph Nodes
- Submental nodes - immediately below chinTeeth, oral mucosa, tongue
- Submandibular nodes - Along angle of mandibleFloor of mouth
- Anterior cervical nodes - over sternocleidomastoidPosterior pharynx, tonsils, parotid
- Posterior cervical nodes - posterior to sternocleidomastoidsScalp, posterior neck
- Suboccipital nodes - below occiputInferior scalp
- Preauricular nodes - Anterior to pinnaEyelids, conjunctivae
- Postauricular nodes - posterior to pinnaExternal auditory meatus, pinna, scalp
- Right supraclavicular node - in right supraclavicular fossaMediastinum, lungs, oesophagus
- Left supraclavicular node (Virchow's node) - in left supraclavicular fossaChest, abdomen
Axillary Lymph Nodes
- Pectoral nodes - anteriorly, behind pectoralis major muscleAnterolateral chest wall, central / lateral breast
- Subscapular nodes - posteriorly, in front of subscapularis musclePosterior neck and chest wall
- Lateral nodes - lateral aspect of armpitMedial hand, forearm and arm
- Central nodes - within centre of axillaDrainage from pectoral, subscapular and lateral nodes
- Infraclavicular nodes - below distal aspect of clavicleLateral hand, forearm and arm
- Apical nodes - medially, at lateral border of 1st ribDrainage from all axillary lymph nodes
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