CTICasesVirchow Node Metastasis from Peritoneal Serous Carcinoma
Imaging findings
A 61-year-old woman presenting with abdominal pain was found on abdominal and pelvic CT to have extensive retroperitoneal lymphadenopathy and peritoneal carcinomatosis. Chest CT performed as part of staging showed a large conglomerate of left supraclavicular lymph nodes at the site where the thoracic duct drains into the subclavian vein.
Key takeaways
Biopsy of the left supraclavicular, or Virchow, node confirmed serous carcinoma, establishing the diagnosis and stage in this case of presumed primary peritoneal serous carcinoma. The case reinforces the importance of routinely evaluating the left supraclavicular region, along the course of the thoracic duct, whenever intra-abdominal or pelvic malignancy and lymphadenopathy are identified, as well as scrutinizing cardiophrenic and internal mammary nodal stations, which can also harbor metastatic disease from abdominal or pleural malignancy even when only minimally enlarged.
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