Supraclavicular nodes

At a glance

English

Supraclavicular nodes

Latin (TA2)

Nodi supraclaviculares

System

Lymphatic

Region

Neck

Side

Paired, left and right

About the supraclavicular nodes

The supraclavicular nodes lie in the greater supraclavicular fossa, the hollow just above the middle of the clavicle and behind the lower end of sternocleidomastoid. They are the lowest members of the deep lateral cervical chain, lying near the junction of the internal jugular and subclavian veins. On the left that junction receives the thoracic duct, which carries lymph from most of the body; on the right it receives the right lymphatic duct. The nodes can be felt in the fossa, best with the patient sitting and the examiner standing behind.

Nearby run the transverse cervical artery, the brachial plexus trunks deeper in the posterior triangle, and the inferior belly of omohyoid. The scalene muscles form the floor of the area.

These nodes receive lymph from the lower neck and the upper chest wall, the arm and axilla by way of the apical axillary nodes, and outflow from the deep cervical chain. Because they sit at the end of the main lymph trunks, they are also reached by cancer cells travelling up from the chest and abdomen.

An enlarged supraclavicular node is always taken seriously. A hard left-sided node, called Virchow's node, may be the first visible sign of a cancer in the abdomen that has spread up the thoracic duct, most classically a stomach cancer; finding it is known as Troisier's sign. Cancers of the pancreas and kidney can do the same. An enlarged right-sided node more often points to a cancer of the lung or oesophagus. On either side, lymphoma, breast cancer and infection of the arm or chest wall are other causes. Rudolf Virchow described the link with stomach cancer in the mid-nineteenth century, and Charles Troisier later showed that other abdominal cancers spread to the same place.

Course and drainage

Begins at

Afferent vessels from the lower neck, the upper chest wall, the arm via the apical axillary nodes and the deep cervical chain; abnormal spread reaches them along the thoracic duct on the left and the right lymphatic duct on the right.

Drains into

Efferent vessels join the jugular and subclavian trunks or open directly into the venous angle between the internal jugular and subclavian veins.

Drains

The last filter before lymph enters the veins. A hard left node can be the first sign of spread from stomach and other abdominal cancers; a right node more often reflects lung or oesophageal cancer; lymphoma can affect either side.