Category Archives: Lymphatic

Virchow’s Node

Virchow’s node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle). It takes its supply from lymph vessels in the abdominal cavity. Virchow’s node is also sometimes coined “the seat of the devil” given its ominous association with malignant disease. The finding of an enlarged, hard node (also referred to as Troisier’s sign) has long been regarded as strongly indicative of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels.

Image from NEJM (link)

The above patient presented with weight loss.  He was found to have gastric cancer.

Left supraclavicular adenopathy can be an indicator of gastric cancer, as in this case. Virchow’s node, or Troisier’s node, refers to carcinomatous involvement of the supraclavicular nodes at the junction of the thoracic duct and the left subclavian vein. Usually, nodal enlargement is caused by metastatic gastric carcinoma, although supraclavicular nodal involvement can also be seen in other gastrointestinal, thoracic, and pelvic cancers. (from NEJM)

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Splenic Rupture CT

Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a situation that requiresimmediate medical attention. The rupture of a normal spleen can be caused by trauma, such as a motor vehicle accident. (from wikipedia)

Image found at medicalschool tumblr (link)

Splenic Rupture on Coronal View of a CT-scan

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The most common causes of splenomegaly in developed countries are infectious mononucleosis, splenic infiltration with cancer cells from a hematological malignancy and portal hypertension (most commonly secondary to liver disease, and Sarcoidosis). Splenomegaly may also come from bacterial infections, such as syphilis or an infection of the heart’s inner lining (endocarditis),

The causes of massive splenomegaly (>1000 g) are much fewer and include:

  • visceral leishmaniasis (kala-azar)
  • chronic myelogenous leukemia
  • myelofibrosis
  • malaria
  • primary lymphoma of spleen

Adapted from wikipedia

The patient below is not from a developed country.  She was treated by the Earthwide Surgical Foundation.

Image from earthwidesurgicalfoundation (link)

“Today we operated on a patient with a large spleen. She was symptomatic with  pain and satiety. Splenomegally is common in the tropics. The causes can be many including parasitic infections (especially malaria), viral infections, blood disorders, infiltrative conditions, congestive splenomegally and tropical splenomegally syndrome. We suspect our lady has a lymphoproliferative disorder since she has a high white count.” (Reblogged from Dr. Camazine’s blogspot)

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Massive Splenomegaly

A 63-year-old man presented with a 6 month history of fatigue, weight loss, and gingival bleeding.  On physical examination, he was found to have a massively enlarged spleen.
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Image from NEJM (Massive Hepatomegaly) link.  Image courtesy J Monterroso

A complete blood count revealed thrombocytopenia (platelet count, 27,000 per microliter; reference range, 150,000 to 400,000) and lymphocytosis (lymphocyte count, 8900 per microliter; reference range, 1000 to 4800). Microscopical examination of a bone marrow aspirate revealed abnormal lymphocytes with abundant light-blue cytoplasm, round nuclei, fine chromatin, and irregular projections of the cell membrane. Similarly abnormal lymphocytes were also evident on microscopical examination of a peripheral-blood smear. These findings confirmed a diagnosis of hairy-cell leukemia. Named for the microscopical appearance of its malignant cells, this uncommon, indolent B-cell non-Hodgkin’s lymphoma often presents with cytopenias, systemic symptoms, and massive splenomegaly. This patient had a complete remission after treatment with the purine analogue cladribine. He remained in remission at his last follow-up, at 9 months, with normal peripheral-blood counts, a normal bone marrow aspirate, and no evidence of splenomegaly. (adapted from NEJM)

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