How many supraclavicular lymph nodes are there

He performed a chest ex ray and did a complete blood count all clear. However, he informed that my lymph node was in fact a supraclavicular node and told me to follow up in 6 weeks. I did, as the node was still there 6 weeks later.

My Dr. Became concerned and referred me to and ent. A week later I went to the ent were he performed an nasal endoscopy all clear. He referred me to a radiologist for imaging of the collarbone region. At this point im scared. Got the imaging and the radiologist report reveal not 1 not 2 not 3 but 4 supraclavicular nodes the biggest just under a centimeter.

The ent doc didnt seem to concerned because they werent huge but i was scared. Ent doc decided he wanted to do an excisional biopsy of one of the nodes to be sure. Did i mention that all of this is taking place during my last semester of law school. Anyway, i got the biopsy and waited two weeks for the results. It was the longest wait ever. Results came back and the Doc informed me that i had ink on one of the nodes from a tattoo i got just above the collar bone 5 years ago.

He said this is rare but it happens. Benign benign benign. Everything was benign. Now im studying for the most important test of my life. I hope my story helps others not worry so much. It sounds like you've been through a very testing time, especially as this happened during your last semester of law school, but I'm so pleased that the results showed that everything was benign.

It really does help to read about other people's experiences and I have no doubt that our members will find your insight invaluable so thank you for sharing your story with us; we really do appreciate it. If etiology is unclear from the history and physical, it is prudent to observe localized adenopathy for 4 weeks before initiating a diagnostic work up, provided the risk of a malignant adenopathy is low. With respect to age and unexplained localized adenopathy, incidence appears to be about 0.

Predictive rules based on some of these epidemiological findings have been used in selecting patients for lymph node biopsy. This article will guide the clinician in deciding when to work up and how to work up localized or generalized lymphadenopathy. Referral to a dedicated lymphadenopathy clinic has been shown to improve diagnostic accuracy and time to intervention. A comprehensive history is important. Always examine for regional malignancies. Axillary adenopathy — cat scratch disease, breast cancer, melanoma or cellulitis of the upper extremity.

With generalized lymphadenopathy the presence of splenomegaly will indicate the possibility of leukemic disorders, lymphomas, miliary tuberculosis, acquired immunodeficiency syndrome, collagen vascular disorders and infectious mononucleosis syndromes.

Initial work-up should include the following: complete blood count with differential, comprehensive metabolic panel, peripheral smear, and chest x-ray. With its capacity to define global cellular function, it can characterize and differentiate tissues at the cellular level. Lymphomas have traditionally been difficult to classify using morphology or Cluster Differentiation CD surface markers. GEP allows diagnostic precision in situations where morphology and immunohistochemistry remain inconclusive.

The next generation of tests enabling further precision in the diagnosis of lymphoma is micro RNA expression profiling. These nucleotide sequences have a greater degree of tissue specificity leading to better diagnostic precision and more accurate tissue typing.

Invasive testing of inguinal nodes should if possible be avoided due to their low diagnostic yield. Management should be based on results of the initial diagnostic workup and may include treatment of systemic or local infectious or inflammatory conditions.

Author: Healthwise Staff. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy.

Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Top of the page. Topic Overview What are lymph nodes? What causes swollen lymph nodes?

The glands on either side of the neck, under the jaw, or behind the ears commonly swell when you have a cold or sore throat.

Glands can also swell following an injury, such as a cut or bite, near the gland or when a tumour or infection occurs in the mouth, head, or neck. Glands in the armpit axillary lymph nodes may swell from an injury or infection to the arm or hand. Clinical approach to lymphadenopathy. Semin Oncol ; — When lymphadenopathy is localized, the clinician should examine the region drained by the nodes for evidence of infection, skin lesions or tumors Table 3.

Other nodal sites should also be carefully examined to exclude the possibility of generalized rather than localized lymphadenopathy. This is an important aspect of the examination, as a study of primary care physicians found that generalized lymphadenopathy was identified in only 17 percent of the patients in whom it was present.

Scalp and neck, skin of arms and pectorals, thorax, cervical and axillary nodes. Infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma. Penis, scrotum, vulva, vagina, perineum, gluteal region, lower abdominal wall, lower anal canal. Infections of the leg or foot, STDs e. Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.

In children, lymph nodes larger than 2 cm in diameter along with an abnormal chest radiograph and the absence of ear, nose and throat symptoms were predictive of granulomatous diseases i. When a lymph node rapidly increases in size, its capsule stretches and causes pain.

Pain is usually the result of an inflammatory process or suppuration, but pain may also result from hemorrhage into the necrotic center of a malignant node. The presence or absence of tenderness does not reliably differentiate benign from malignant nodes. Stony-hard nodes are typically a sign of cancer, usually metastatic. Very firm, rubbery nodes suggest lymphoma.

Softer nodes are the result of infections or inflammatory conditions. Suppurant nodes may be fluctuant. The anatomic location of localized adenopathy will sometimes be helpful in narrowing the differential diagnosis. For example, cat-scratch disease typically causes cervical or axillary adenopathy, infectious mononucleosis causes cervical adenopathy and a number of sexually transmitted diseases are associated with inguinal adenopathy Table 4.

Supraclavicular lymphadenopathy has the highest risk of malignancy, estimated as 90 percent in patients older than 40 years and 25 percent in those younger than age Lymphadenopathy of the right supraclavicular node is associated with cancer in the mediastinum, lungs or esophagus.

The left supraclavicular Virchow's node receives lymphatic flow from the thorax and abdomen, and may signal pathology in the testes, ovaries, kidneys, pancreas, prostate, stomach or gallbladder.

Although rarely present, a paraumbilical Sister Joseph's node may be a sign of an abdominal or pelvic neoplasm. In patients with generalized lymphadenopathy, the physical examination should focus on searching for signs of systemic illness.

The most helpful findings are rash, mucous membrane lesions, hepatomegaly, splenomegaly or arthritis Table 4. Splenomegaly and lymphadenopathy occur concurrently in many conditions, including mononucleosis-type syndromes, lymphocytic leukemia, lymphoma and sarcoidosis. Laboratory tests that may be useful in confirming the cause of lymphadenopathy are listed in Table 4. The presence of certain characteristic clinical syndromes may help the physician determine a suspected cause of lymphadenopathy.

Patients with these syndromes present with lymphadenopathy, fatigue, malaise, fever and an increased atypical lymphocyte count. Mononucleosis is most commonly due to Epstein-Barr virus infection.

The presence of the typical syndrome and positive results on a heterophilic antibody test Monospot test confirms the diagnosis. The most common cause of heterophil-negative mononucleosis is early Epstein-Barr virus infection.

False-negative results on heterophilic antibody tests are especially common in patients younger than four years of age. Epstein-Barr virus infection may be confirmed by repeating the Monospot test in seven to 10 days. Rarely is it necessary to confirm the diagnosis with IgM viral capsid antigen or early antigen antibody titers. If Epstein-Barr virus antibodies are absent, other causes of the mononucleosis syndrome should be considered.

These include toxoplasmosis, cytomegalovirus infection, streptococcal pharyngitis, hepatitis B infection and acute human immunodeficiency virus HIV infection. Acute infections with cytomegalovirus and Toxoplasma may be identified with IgM serology for those organisms. This syndrome is defined by the presence of a skin lesion with associated regional lymphadenopathy.

The classic cause is tularemia, acquired by contact with an infected rabbit or tick; more common causes include streptococcal infection e. This syndrome involves the combination of conjunctivitis and associated preauricular nodes.

Common causes include viral kerato-conjunctivitis and cat-scratch disease resulting from an ocular lesion. Enlargement of the lymph nodes that persists for at least three months in at least two extrainguinal sites is defined as persistent generalized lymphadenopathy and is common in patients in the early stages of HIV infection.

Other causes of generalized lymphadenopathy in HIV-infected patients include Kaposi's sarcoma, cytomegalovirus infection, toxoplasmosis, tuberculosis, cryptococcosis, syphilis and lymphoma. The decision will depend primarily on the clinical setting as determined by the patient's age, the duration of the lymphadenopathy and the characteristics and location of the nodes. Because generalized lymphadenopathy almost always indicates that a significant systemic disease is present, the clinician should consider the diseases listed in Table 4 and proceed with specific testing as indicated.

If a diagnosis cannot be made, the clinician should obtain a biopsy of the node. The diagnostic yield of the biopsy can be maximized by obtaining an excisional biopsy of the largest and most abnormal node which is not necessarily the most accessible node.

If possible, the physician should not select inguinal and axillary nodes for biopsy, since they frequently show only reactive hyperplasia. If the lymphadenopathy is localized, the decision about when to biopsy is more difficult.

Patients with a benign clinical history, an unremarkable physical examination and no constitutional symptoms should be reexamined in three to four weeks to see if the lymph nodes have regressed or disappeared. Patients with unexplained localized lymphadenopathy who have constitutional symptoms or signs, risk factors for malignancy or lymphadenopathy that persists for three to four weeks should undergo a biopsy.

Biopsy should be avoided in patients with probable viral illness because lymph node pathology in these patients may sometimes simulate lymphoma and lead to a false-positive diagnosis of malignancy.

Many patients worry about the cause of their abnormal lymph nodes. To adequately address their fears, the physician should ask the patient about his or her concerns and respond to questions about specific diagnoses. When biopsy is deferred, the physician should explain to the patient the rationale for waiting.