Supraclavicular lymph nodes
Nodi lymphoidei supraclaviculares
Also known as: Virchow node, Troisier sign, signal node, scalene nodes
The lowest deep cervical nodes in the supraclavicular fossa, near the termination of the thoracic and right lymphatic ducts; a palpable supraclavicular node is always abnormal and often malignant.
Overview
The supraclavicular nodes are the most inferior members of the deep cervical chain (levels IV and Vb), lying in the fat of the supraclavicular fossa around the lower internal jugular vein and transverse cervical vessels, on scalenus anterior (hence "scalene nodes"). Because they sit beside the terminations of the great lymphatic ducts, they can receive lymph — and tumour cells — retrogradely or by overflow from the thorax and abdomen as well as from the head, neck, breast and arm.
The left supraclavicular node, near the termination of the thoracic duct, is the Virchow (signal) node; its enlargement (Troisier sign) classically signals gastric carcinoma, but also pancreatic, gallbladder, colorectal, ovarian, testicular, prostatic and renal cancers and lymphoma. The right supraclavicular nodes drain the mediastinum, lungs and oesophagus, so enlargement suggests thoracic malignancy. Supraclavicular nodes have the highest malignancy risk of any node group (≈ 50% or more in many series, rising with age).
- Location
Supraclavicular fossa (posterior to the clavicle, lateral to the clavicular head of sternocleidomastoid, around the lower internal jugular vein and on scalenus anterior).
Anatomy
- Lymphatic drainage
To the jugular trunk, or directly into the thoracic duct/right lymphatic duct or venous angle.
Function
- Filter lymph from the lower neck, and from the thorax, breast and abdomen near the terminations of the lymphatic ducts.
Clinical significance
Examination
Palpate from behind the seated patient with the shoulders relaxed, asking them to shrug or perform a Valsalva manoeuvre, which brings nodes up from behind the clavicle. Any palpable supraclavicular node warrants imaging and biopsy.
Staging significance
Supraclavicular (and scalene) node involvement is N3 disease in lung cancer and distant/advanced spread in many abdominal cancers.
Test yourself
An enlarged left supraclavicular lymph node (Virchow node) most classically suggests…
- Carcinoma of the right lung
- Gastric carcinoma
- Tonsillitis
- Carcinoma of the lower lip
Answer: Gastric carcinoma
The thoracic duct ends at the left venous angle, so malignant cells from the abdomen can lodge in the left supraclavicular nodes. A palpable Virchow node (Troisier sign) is classically due to gastric carcinoma.
Compiled from standard anatomy and physiology references — see the Lymphatic & Immune System sources. For education only; not medical advice.