Differential Diagnosis for Supraclavicular Lymphadenopathy

Single Most Likely Diagnosis

• Metastatic cancer: This is often the first consideration due to the high frequency of malignancies presenting with or metastasizing to the supraclavicular lymph nodes. Common sources include lung, breast, and abdominal cancers.

Other Likely Diagnoses

• Tuberculosis (TB): TB can cause lymphadenopathy in any location, including the supraclavicular region, especially in endemic areas or in individuals with risk factors for TB exposure.
• Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with supraclavicular lymphadenopathy, either as the primary site or as part of systemic disease.
• Infections: Other infections such as cat-scratch disease, toxoplasmosis, or histoplasmosis can also cause supraclavicular lymphadenopathy, though they are less common.

Do Not Miss Diagnoses

• Thyroid cancer: Though less common, thyroid cancer can metastasize to the supraclavicular lymph nodes. Given the potential for aggressive disease, it's crucial not to miss this diagnosis.
• Sarcoidosis: While often presenting with hilar lymphadenopathy, sarcoidosis can also involve the supraclavicular nodes. Missing this diagnosis could lead to delayed treatment of a potentially systemic disease.
• Castleman disease: A rare lymphoproliferative disorder that can present with lymphadenopathy, including in the supraclavicular region. It's essential to consider due to its potential for significant morbidity if untreated.

Rare Diagnoses

• Kikuchi-Fujimoto disease: A rare, self-limiting condition that predominantly affects young women, characterized by lymphadenopathy, often in the supraclavicular region.
• Kimura disease: A chronic inflammatory disorder that can cause lymphadenopathy and eosinophilia, more commonly seen in Asian males.
• Rosai-Dorfman disease: A rare histiocytic disorder that can present with lymphadenopathy, including in the supraclavicular region, along with other systemic symptoms.

Each of these diagnoses has a unique set of clinical and pathological features. A thorough history, physical examination, and appropriate diagnostic tests (such as imaging and biopsy) are essential for determining the underlying cause of supraclavicular lymphadenopathy.