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

Answered by
Dr. Uphar Gupta
and medically reviewed by iCliniq medical review team.
Published on Aug 29, 2018 and last reviewed on: Jun 11, 2019

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?

Dr. Uphar Gupta

General Medicine Internal Medicine
#

Hello,

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).

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

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?

Dr. Uphar Gupta

General Medicine Internal Medicine
#

Hello,

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

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