Figure 1: Click on image to enlarge.




The panel above shows the fullness of the left clavicular fossa (inside the red circle) secondary to the enlargement of the lymph node “Virchow’s node’.


Virchow's node is an enlarged left supraclavicular lymph node, which has been associated with various gastrointestinal malignancy in particular gastric malignancies. It was first described by Dr Rudolf Virchow (1821-1902), a German pathologist after describing the association of enlarged lymph nodes in the supraclavicular region with underlying gastric malignancy in 1848.


It is also referred to as the sentinel node or signal node for abdominal malignancies, in particular the upper gastrointestinal malignancies. However, it is not the first node to receive drainage from any of the abdominal pathology. It was referred to as a sentinel nodes as in the past without imaging, it is the first clinically detectable lymph node enlargement to indicate the presence of an underlying malignancy. It is well-known that any malignancies of intra-abdominal origin can be insidious and can metastatise without producing symptoms, until at its advance stage.  On imaging, enlarged abdominal and mediastinal lymph nodes are often detected in the presence of a Virchow’s node.


Virchow's node is also known as Troisier’s sign, after the French pathologist Charles Emile Troisier who described its association with other abdominal malignancies in 1889.


The supraclavicular node is often affected due to it’s location on the left side of the neck close to the drainage of the thoracic duct. The thoracic duct drains lymph from most part of the body into the venous circulation via the left subclavian vein. When the thoracic duct is blocked by metastasis, lymph is regurgitated into the surround lymph node causing enlargement (Virchow’s node). Another explanation is that one of the supraclavicular nodes corresponds to the end node along the thoracic duct and hence the enlargement.



Image and text contributed and prepared by

Dr Nurulummi Adanan and edited by Dr Chong Vui Heng, Department of Internal Medicine, RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.