Lymph Node Exam

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

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