Lymph Node Exam
Palpation of the lymph nodes provides information about the possible presence of a malignant or inflammatory process and the localization or generalization of that process.
Lymph Node Exam Findings
- Insignificant if < 2cm
- In axilla and inguinal, insignificant if < 3cm
- In the supraclaviclar fossa > 1cm is significant
- soft (insignificant), rubbery (classically lymphoma) , hard (classically malignancy & granulomatous infection).
Tender (classically infection) vs. non-tender (classically malignancy)
- Patient 2-12 years old commonly present with insignificant lymph nodes in neck secondary to frequent viral infection.
Lymph Node Exam Technique
- Always evaluate for symmetry: clinically significant nodes classically asymmetric.
- Identify salivary glands by location as non-lymph nodes.
- Identify carotid artery/bulb by pulsation as non-lymph nodes.
- Supraclavicular fossa most significant area: often indicates a process deep in body.
- Left supraclavicular node (Virchow’s node) classical sign of abdominal process.
- Right superclavicular node classic sign of intrathoracic process.
- Trim fingernails!
- Infraclavicular fossa nodes: classically breast cancer or malignant lymphoma.
- Epitrochlear lymph nodes: best felt when moving fingers up and down.
Consult the Expert
Dr. Saul Rosenberg
Dr. Saul Rosenberg is a Stanford University Emeritus Professor and a luminary in the research and treatment of Hodgkin's Disease and other lymphomas. He is also a skilled bedside examiner and has wonderful tips for examining the spleen and lymph nodes. During the department’s Osler Evening forum, Dr. Abraham Verghese interviewed Dr. Rosenberg about his career and inspiring life story.
Enlarged inguinal lymph nodes are very common. Usually, they are shotty lymph nodes which are small, often hard, lymph nodes that are usually of no clinical concern. The term "shotty" comes from that fact that they have a similar feel to buckshot or pellets.
Key Learning Points
Learn the proper technique of the lymph node exam
The Stanford Medicine 25
- Gait Abnormalities
- Fundoscopic Exam
- Ankle Brachial Index
- Cerebellar Exam
- Hand Exam
- Lymph Node Exam
- Cardiac Second Sounds
- Pulsus Paradoxus and Blood Pressure Measurement Techniques
- Neck Veins & Wave Forms
- Precordial Movements in the Cardiac Exam
- Pulmonary Exam: Percussion & Inspection
- Examination of the Spleen
- Examination of the Liver
- Liver Disease, Head to Foot
- Ascites & Venous Patterns
- Examination of the Tongue
- Thyroid Exam
- Low Back Exam, Approach to
- Hip Region Exam, Approach to
- Knee Exam
- Shoulder Exam
- Deep Tendon Reflexes
- Pupillary Responses
- Involuntary Movements
- Internal Capsule Stroke
- Dermatology Exam: Learning the Language
- Dermatology Exam: Nevi (Mole) Exam
- Dermatology Exam: Acne vs. Rosacea
- Bedside Ultrasound
- Rectal Exam