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Understanding the significance of virchow's node

By John Joseph Pack MD

Published on 05/10/2026

An enlarged, firm, non-tender supraclavicular lymph node should immediately raise the suspicion of metastatic disease, classically gastric in origin, but other possibilities include testicular, esophageal, lung, pancreas, and ovarian. The metastatic lymph node is seeded via the thoracic duct.  The thoracic duct empties into the venous circulation at the venous angle, the junction between the left internal jugular vein and the left subclavian vein. This conduit allows lymph fluid to re-enter the systemic circulation. Tuberculosis, Sarcoidosis, and Toxoplasmosis are non-neoplastic causes of supraclavicular lymph nodes. Biopsy and imaging should be obtained. 

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