Left supraclavicular (Virchow's) node

Local vessels and regional nodes · Troisier's sign

The most medial node of the left supraclavicular group sits where the thoracic duct terminates, so tumour emboli carried up the duct from any abdominal or pelvic organ can lodge in it. A palpable hard node there is Troisier's sign.

Traced from the start

  1. Gut and abdominal visceraTestis and ovary
  2. Left supraclavicular (Virchow's) node

Detail

Site
Left supraclavicular fossa at the thoracic duct termination
Sign
Troisier's sign when palpable
Classic primary
Gastric adenocarcinoma
Also from
Pancreas, oesophagus, colon, kidney, testis, ovary, lung, lymphoma
Right supraclavicular node
Points instead to a thoracic (lung, oesophagus) or right-sided source

When it goes wrong

Advanced gastric carcinoma seeding the duct terminus

Hard fixed left supraclavicular node signifying M1, incurable disease

Any new supraclavicular node in an adult

Mandates a search for an abdominal or thoracic primary before anything else

Practise this structure

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