left supraclavicular lymph node swollen sign

1 The eponyms “Troisier” and “Virchow” acknowledge the individuals who identified the enlargement of supraclavicular nodes as a clinical sign of gastric cancer metastasis in the mid-to-late 19 th century. The enlarged supraclavicular lymph node is known as a Virchow node (VN), Troisier node, or Virchow-Troisier node. The Troisier sign represents an enlargement of a left-sided supraclavicular lymph node.

Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. Recognition of the Troisier sign/VN is of great clinical importance. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease.

The VN is of profound clinical importance however, there have been few studies of its regional anatomical relationships. Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically - a Troisier sign.

Left supraclavicular lymph node swollen sign