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Supraclavicular lymph nodes

Supraclavicular lymph nodes are deep and superficial lymph nodes located just above the clavicle, along the posterior triangle of the neck, near the junction of the thoracic duct (left side) or right lymphatic duct (right side) with the subclavian vein. These nodes are part of the lower cervical lymphatic chain and are clinically significant due to their role in draining lymph from the head, neck, thorax, and abdomen. Typically, they measure 2–10 mm in healthy adults and are not palpable unless enlarged. The left supraclavicular nodes (Virchow’s nodes) are particularly important as a sentinel sign of thoracic or abdominal malignancy, while the right-sided nodes primarily drain the mediastinum and right upper thorax.

Synonyms

  • Lower cervical lymph nodes

  • Virchow’s nodes (left-sided, when enlarged)

  • Clavicular lymph nodes

  • Posterior cervical lymph nodes

Function

  • Drain lymph from head, neck, thorax, and abdomen

  • Act as immune surveillance nodes, filtering pathogens and abnormal cells

  • Serve as sentinel nodes for malignancies in thoracic or abdominal regions

  • Connect with the thoracic duct (left) or right lymphatic duct (right) to return lymph to venous circulation

MRI Appearance

T1-weighted images:

  • Normal nodes appear as small, oval, hypointense to intermediate signal structures within the supraclavicular fat

  • Surrounded by hyperintense subcutaneous fat, providing contrast

  • Pathological nodes may appear enlarged, rounded, or with cortical thickening

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal nodes may show mild homogeneous enhancement

  • Enlarged or metastatic nodes often demonstrate intense, homogeneous, or heterogeneous enhancement

  • Contrast helps identify cortical involvement, necrosis, or abnormal vascularity

T2-weighted images:

  • Nodes appear intermediate to slightly hyperintense, with surrounding fat bright

  • Useful for detecting edema, inflammatory infiltration, or metastatic deposits

  • Fatty hilum (if present) is mildly hyperintense compared to cortex

STIR (Short Tau Inversion Recovery):

  • Fat suppression allows clear visualization of edema, inflammation, or pathology

  • Normal nodes remain hypointense, whereas inflamed, infected, or metastatic nodes appear hyperintense

  • Useful for subtle lymphadenopathy or early disease detection

CT Appearance:

  • Nodes are soft tissue density structures located superficial or deep to the clavicular fascia, above the clavicle

  • Surrounded by fat (hypodense) and adjacent vascular structures

  • Enlarged or pathological nodes appear as well-defined, rounded, or irregular soft tissue masses, sometimes with central low density if necrotic

  • CT is valuable for staging malignancy, evaluating infections, or guiding biopsy

MRI images

Supraclavicular lymph nodes mri axial image -img-00000-00000