HomeAnswersInternal Medicinehypoechoic noduleWhat does a lump under collar bone on right side mean?

There is a lump above my left collarbone. Is it cancerous?

There is a lump above my left collarbone. Is it cancerous?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Uphar Gupta

Medically reviewed by

iCliniq medical review team

Published At August 29, 2018
Reviewed AtDecember 2, 2020

Patient's Query

Hello doctor,

I consulted two doctors regarding a lump that I could feel above my left collarbone, whenever I strain or turn my neck. Both the doctors said that it was just a prominent tendon, but gave me an ultrasound to ease my mind. The ultrasound said 'there is a 6 by 4 mm hypoechoic nodule in my left supra clavicular area, presumably representing a small lymph node. If clinically indicated, an MRI or a CT can be done for further evaluation.

On seeing the reports, one of the doctors said that I need a biopsy right away. The other doctor referred me to an ENT. I followed up with the ENT, but he was not able to feel the lymph node and said that the lump is just a prominent muscle and nothing to worry about. The ENT also said that the ultrasound was normal and that a 6 by 4 mm node is normal and nothing to worry about.

I have been reading online, and it is mentioned everywhere that a hypoechoic nodule is cancerous, especially in the left collar bone area. What does a hypoechoic nodule mean? Does this mean it is a small cancerous lymph node?

What does it mean by 'if clinically indicated, a CT or MRI can be done for further evaluation.'? I also had a CBC done, and that was normal. I had a neck CT done six months ago for a pulled muscle, and that was normal as well.

If it did not detect this small nodule six months back, can it have grown in just six months? Is hypoechoic bad? Why did the ultrasound say presumably a lymph node? I am so worried now. Do I need a biopsy or is there nothing to worry about?

Answered by Dr. Uphar Gupta


Welcome to icliniq.com.

There is a lymph node in the left supraclavicular region called as Virchow's node. If enlarged, it may indicate a malignancy of the abdominal region as that is the draining pathway of the lymph from that area.

A lymph node from cancer is generally very hard to palpate. A soft node is generally secondary to some inflammatory response, generally an infection.

Please ask your doctor to have a look at your abdomen and re-evaluate the node, although I am almost certain, it is nothing but an inflamed node. As it is of a short duration, it is highly unlikely to be anything dangerous.

I suggest you get the following tests:

  • ESR (erythrocyte sedimentation rate).
  • CRP (C-reactive protein).
  • HRCT ABDOMEN (high-resolution computed tomography).

Are you scared that the lump in your collarbone is cancer? Get a medical second opinion online now.

Patient's Query

Hello doctor,

Thanks for replying. I already know that gastric cancer can metastasize to the Virchow's node. I have had a CT scan of the abdomen and pelvis three months ago as well as a transnasal esophagoscopy 10 months ago. An upper GI a month ago and a neck CT scan eight months ago.

These scans were done due to a hiatal hernia and acid reflux. All the scans were normal. So, gastric cancer would be highly unlikely. However, upon three doctor's examinations, no nodes were palpable and if this was the Virchow's node, it would have stated so on the ultrasound.

So, that was not my question. My question was about the hypoechoic node itself. Is a hypoechoic nodule a normal finding for a lymph node? Is 6 by 4 mm a normal size for a clavicle node. What is the actual size for a clavicle node? And if my nodes are not palpable, is this ultrasound normal?

Answered by Dr. Uphar Gupta


Welcome back to icliniq.com.

A significant lymph node in the neck is one that is greater than 1 cm in the long axis. As your node in 6 mm in the long axis and 4 mm in the short axis, there is absolutely nothing to worry about.

Normal, reactive, lymphomatous and tuberculous lymph nodes are predominantly hypoechoic when compared to the adjacent muscles. So, echogenicity is only a hint that this is a lymph node and this is not a metastasis from papillary thyroid carcinoma.

Hypoechoic does not mean abnormal. Hope that answers your question.

Basically, this is a lymph node of a size too small to be a malignancy or a metastasis. My frank opinion is that this is neither cancerous nor a metastasis from another cancer.

For more information consult an internal medicine physician online --> https://icliniq.com./ask-a-doctor-online/internal-medicine-physician

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Uphar Gupta
Dr. Uphar Gupta

Internal Medicine

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