𝗩𝗶𝗿𝗰𝗵𝗼𝘄'𝘀 𝗡𝗼𝗱𝗲 (Why Left side?🤔)

𝗩𝗶𝗿𝗰𝗵𝗼𝘄'𝘀 𝗡𝗼𝗱𝗲 (ᴛʀᴏɪsɪᴇʀ's  sɪɢɴ ,sɪɢɴᴀʟ ɴᴏᴅᴇ,sᴇɴᴛɪɴᴇʟ ɴᴏᴅᴇ,sᴇᴀᴛ ᴏғ ᴛʜᴇ ᴅᴇᴠɪʟ ɴᴏᴅᴇ, ᴠɪʀᴄʜᴏᴡ's-ᴛʀᴏɪsɪᴇʀ's  ɴᴏᴅᴇ)

"𝙰𝚗 𝚒𝚖𝚙𝚘𝚛𝚝𝚊𝚗𝚝 𝚌𝚕𝚞𝚎 𝚝𝚘 𝚊𝚋𝚍𝚘𝚖𝚒𝚗𝚊𝚕 𝚖𝚊𝚕𝚒𝚐𝚗𝚊𝚗𝚌𝚒𝚎𝚜 𝚍𝚞𝚎 𝚝𝚘 𝚒𝚝𝚜 𝚜𝚞𝚙𝚎𝚛𝚏𝚒𝚌𝚒𝚊𝚕 𝚕𝚘𝚌𝚊𝚝𝚒𝚘𝚗"

🕳️Rudolf Ludwig Karl Virchow, in 1849, noted the involvement of left supraclavicular node in relation to the junction of the thoracic duct, adjacent to medial to the IJV; this end node drains through few lymphatics into the left jugular trunk and to thoracic duct. Reflux from thoracic duct into this node occurs easily in abdominal malignancy.

🕳️40 years later, Troisier reported many cancers ( 𝗴𝗮𝘀𝘁𝗿𝗶𝗰,𝗼𝗲𝘀𝗼𝗽𝗵𝗮𝗴𝗮𝗹,𝗽𝗮𝗻𝗰𝗿𝗲𝗮𝘁𝗶𝗰, 𝗴𝗲𝗻𝗶𝘁𝗼-𝘂𝗿𝗶𝗻𝗮𝗿𝘆, 𝗟𝘂𝗻𝗴𝘀

𝗛𝗲𝗽𝗮𝘁𝗼𝗯𝗶𝗹𝗶𝗮𝗿𝘆, 𝗕𝗿𝗲𝗮𝘀𝘁 & 𝗘𝘃𝗲𝗻 𝗶𝗻 𝗧.𝗕, 𝗟𝘆𝗺𝗽𝗵𝗼𝗺𝗮, 𝗛𝘆𝗱𝗮𝘁𝗶𝗱 𝗰𝘆𝘀𝘁, 𝗦𝗖𝗖 ) presenting with left supraclavicular lymph node involvement as external indicator and so coined the term Virchow's node and sign is called as Troisier sign. 

🕳️At the level of left C7 transverse process, thoracic duct arches behind the carotid sheath and IJV and joins the junction of IJV and left subclavian vein; this Virchow's(end node along the thoracic duct) is located medial to this junction behind the muscular lateral head of left sternocleidomastoid muscle or in between the two heads."𝐓𝐡𝐞 𝐬𝐢𝐳𝐞 𝐨𝐟 𝐧𝐨𝐝𝐞 𝐢𝐬 𝐮𝐬𝐮𝐚𝐥𝐥𝐲 3×2.5𝐜𝐦"

🕳️𝗩𝗡 is also called as 'signal node' or seat of the devil' node. Virchow's node is actually part of the lower deep cervical node (level IV). Its surface marking almost corresponds to end of the thoracic duct i.e. just above the sternal angle of the clavicle 1.5 cm left of the midline. Node is just medial to this point. 

𝗘𝗙𝗙𝗘𝗖𝗧𝗦 𝗢𝗙 𝗩𝗡:

Outside of its role as a signal node, the VN may, itself, cause signs and symptoms from its mass effect; VN may lead to 

-ʜᴏʀɴᴇʀ's sʏɴᴅʀᴏᴍᴇ.

-ʙʀᴀᴄʜɪᴀʟ ᴘʟᴇxsɪs ᴘᴀʀᴀʟʏsɪs.

-ʟᴛ ᴘʜʀᴇɴɪᴄ ɴᴇʀᴠᴇ ᴄᴏᴍᴘʀᴇssɪᴏɴ. ʟᴇᴀᴅɪɴɢ ᴛᴏ ᴅɪᴀᴘʜʀᴀɢᴍ ᴘᴀʀᴀʟʏsɪs.

-ᴛʜᴏʀᴀᴄɪᴄ ᴏᴜᴛʟᴇᴛ sʏɴᴅʀᴏᴍᴇ.

-ᴄᴏᴍᴘʀᴇsᴅɪᴏɴ ᴏғ sᴜʙᴄʟᴀᴠɪᴀɴ ᴀʀᴛᴇᴛʏ & ᴄᴇʀʙɪᴄᴀʟ sʏᴍᴘʜᴛᴀᴛɪᴄ ᴄʜᴀɪɴ.