Expansion
Site, size, consistency, tenderness, fixation and the drainage area
Expansion
Cervical chain, examined from behind
- Submental
- Submandibular
- Pre-auricular
- Post-auricular
- Occipital
- Superficial cervical, along the sternocleidomastoid
- Deep cervical
- Posterior triangle
- Supraclavicular
Then axillary, epitrochlear, inguinal and popliteal, plus liver and spleen.
What to describe
- Site and whether localised or generalised
- Size, in centimetres; over 1 cm is usually significant, over 2 cm more so
- Consistency: soft, rubbery, hard, fluctuant
- Tenderness
- Mobility: mobile, matted or fixed to skin or deep structures
- Overlying skin change or sinus
Interpretation
| Character | Suggests |
|---|---|
| Tender, soft, mobile | Infection |
| Rubbery, mobile, painless | Lymphoma |
| Hard, fixed, painless | Carcinoma |
| Matted, may discharge | Tuberculosis |
Virchow’s node, a left supraclavicular node, drains the thoracic duct and signals intra-abdominal malignancy, classically gastric. When palpable with a positive Troisier sign it is a genuinely useful physical finding.
Localised lymphadenopathy demands examination of the whole drainage area including the skin, scalp, mouth, ears and the limb distal to it.