The Stanford 25

An Initiative to Revive the Culture of Bedside Medicine

Lymph Node Exam (with Dr Saul Rosenberg)

Dr. Saul Rosenberg is a luminary in the research and treatment of Hodgkin’s Disease. In the videos below, Dr. Rosenberg shares some of his knowledge in the clinical evaluation of lymph nodes and demonstrates his exam technique. During the department’s Osler Evening forum, Dr. Abraham Verghese interviewed Dr. Rosenberg about his career and inspiring life story.


Introduction: We were very privileged to have Dr. Saul Rosenberg,  a pioneer in the treatment of Hodgkin’s disease and other lymphomas  allow us to videotape him as he illustrated the lymph node and spleen exam for us.

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.

Findings

  • Size: insignificant if < 2cm, except in axilla then < 3cm. In the supraclaviclar fossa > 1cm is significant.
  • Consistency: soft (insignificant), rubbery (classically lymphoma) , hard (classically malignancy & granulatous 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.


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 indicate 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.
  • Here nodes are commonly enlarged to 3-4cm, when small termed “shotty.”

       

  • Examination of spleen is important part of examination of lymphoid tissue.
  • Normally not felt except in thin body habitus.
  • For closer examination, have patient lean on right side, bring knees up, repeat process.

For a great article by our very own Dr. Jeffrey Chi please see Why Lymph Nodes Matter.

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Written by stanford25admin

June 7, 2010 at 2:56 pm

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