What parts of the body does Virchow's (left supraclavicular) node drain?

Virchow's Node Drainage Patterns

Virchow's node (left supraclavicular lymph node) primarily drains malignancies from the abdomen, pelvis, thorax, and genitourinary tract, with a strong predilection for abdominal and pelvic cancers. 1

Primary Drainage Regions

Abdomen and Pelvis (Strongest Association)

• All primary abdominal malignancies (100%) and the vast majority of pelvic tumors (84%, 16/19) metastasize specifically to the left supraclavicular node 1
• Gastric cancer classically involves Virchow's node, representing the "end node" along the thoracic duct drainage pathway 2
• Ovarian carcinoma can present with isolated left supraclavicular adenopathy, though this is rare 3
• Genitourinary malignancies also drain to this location 4

Thorax

• Pulmonary malignancies metastasize to supraclavicular nodes bilaterally with no left-sided predilection 1, 4
• Small-cell neuroendocrine carcinoma of the lung can present with bilateral Virchow nodes 4
• Esophageal cancers drain to cervical lymph nodes as part of three-field lymphadenectomy patterns 5

Breast and Head/Neck

• These malignancies show no preferential drainage pattern to left versus right supraclavicular nodes 1

Anatomical Basis

The left-sided predilection exists because:

• The thoracic duct drains into the left venous angle, making the left supraclavicular node the "end node" along this route 6, 2
• The thoracic duct divides into 3-10 collateral ducts that surround this node, with multiple communication sites 2
• The node's unique histology shows fragmented cortex areas creating an "island-like arrangement" that may limit filtration function 2

Clinical Significance

When evaluating an enlarged left supraclavicular node without right-sided involvement, prioritize investigation for abdominopelvic malignancy 1, 6:

• 60.4% of malignant supraclavicular biopsies involve the left side 1
• Fine-needle aspiration biopsy is the excellent initial diagnostic procedure 1
• The finding warrants expedited CT imaging of abdomen/pelvis to identify the primary source 6

Important Caveats

• 10.4% of enlarged supraclavicular nodes represent lymphoma or leukemia rather than metastatic carcinoma 1
• 7.1% remain metastases of unknown primary despite workup 1
• Inflammatory conditions including tuberculosis account for 19.8% of cases 1
• Bilateral supraclavicular adenopathy suggests thoracic primary or lymphoproliferative disease rather than abdominal malignancy 4