Lymph node groups
- Occipital, preauricular, postauricular
- Submental, submandibular
- Cervical: anterior, posterior, deep
- Clavicular: supraclavicular, infraclavicular
- Axillary: anterior (pectoral), lateral, posterior (subscapular), apical, medial
- Epitrochlear, inguinal
Inspection
- Lymphedema
- Surgical scars from cancer excision
- Obvious masses
Palpation
- Technique
- Use the pads of the digiti indices and digiti profanus to move the skin in circular motions over the underlying tissues in each area; palpated both sides of the neck simultaneously
- Small nodes (< 1cm) are normal unless in unusual location (preauricular).
- Abnormal nodes:
- Location
- Size
- Delimination (discrete or matted together)
- Mobile or fixed
- Consistency (soft, hard, firm)
- Tenderness
Preauricular – in front of tragus of ear (eye)
Postauricular – behind ear, over mastoid process (ear)
Occipital – posterior to mastoid process, at base of skull
Submental – inside mentus of the mandible (floor of mouth)
Submandibular – near submandibular salivary glands (oral cavity)
Cervical chains
- Anterior chain runs along the SCM (pharynx, tonsils)
- Posterior chain runs along the trapezius
Clavicular (abdomen, thorax, breast)
- Supraclavicular – Virchow’s node (ominous finding in cancer patient)
Axillary
- Lateral (arm), medial
- Apical – need to push very hard
- Anterior (anterior chest wall, most of breast)
- Posterior (posterior chest wall, upper arm)
Epitrochlear – while shaking the patient’s hand, feel the epitrochlear area
Inguinal – “shotty” nodes are small, mobile and discrete (normal)
Abnormal → (SLAP) – spleen, liver exam; associated lymph sites; search for a primary site