🧠 Lymphatic Drainage Associations: The Ultimate Visual Guide for Boards
The lymphatic system plays a key role in immune surveillance, fluid balance, and cancer metastasis. On exams like the USMLE Step 1, Step 2, or NCLEX, lymph node patterns often reveal the origin of disease — particularly infections, malignancies, or systemic disorders.
🔍 High-yield questions often ask:
“Which lymph node drains this area?”
or
“Which pathology is associated with enlargement of [node]?”
🧬 Table: Lymph Nodes, Drainage & Clinical Associations
| Lymph Node Cluster | Drains | Pathology Clue |
|---|---|---|
| Submandibular | Oral cavity | Oral cancer |
| Deep Cervical | Head, neck, oropharynx | Mono, Kawasaki, Head/Neck cancer |
| Supraclavicular (Virchow) | Abdomen, pelvis | Gastric or GI malignancies |
| Mediastinal | Trachea, esophagus | TB, sarcoidosis |
| Hilar | Lungs | Lung cancer, granulomatous disease |
| Axillary | Upper limb, breast, skin above umbilicus | Breast cancer, mastitis |
| Epitrochlear | Hand, forearm | Secondary syphilis |
| Periumbilical (Sister Mary Joseph) | Abdomen, pelvis | Gastric cancer |
| Celiac | Liver, stomach, spleen, pancreas | Celiac disease, mesenteric adenitis |
| Superior Mesenteric | Small intestine | IBD, Crohn’s |
| Inferior Mesenteric | Colon from splenic flexure to rectum | Ulcerative colitis, colorectal cancer |
| Para-aortic | Kidneys, gonads, uterus | Testicular/ovarian cancer |
| External Iliac | Cervix, upper bladder, uterus | STIs, pelvic tumors |
| Internal Iliac | Rectum, bladder, cervix, prostate | Prostate cancer, cervical cancer |
| Superficial Inguinal | Anal canal (below pectinate), vulva, scrotum | Lower STI lesions, vulvar cancer |
| Popliteal | Dorsolateral foot, calf | Foot cellulitis |
🧠 Mnemonics & Tips
Virchow = Viscera → Think GI tract metastasis
Sister Mary Joseph = Stomach → Always signals gastric origin
Popliteal = Posterior foot → Often shows lateral foot cellulitis
🩺 USMLE Question Style
"A 40-year-old woman presents with a painless supraclavicular mass. What is the most likely primary site of malignancy?"
✅ Answer: Stomach (Virchow node)
These patterns are frequently tested in pathology, anatomy, and oncology sections.
🧬 High-Yield Associations Summary
| Node | Most Common Pathology |
|---|---|
| Axillary | Breast cancer |
| Virchow | Gastric carcinoma |
| Inguinal | Genital ulcers, STIs |
| Para-aortic | Testicular, ovarian cancer |
| Periumbilical | Gastric cancer (late sign) |
| Mediastinal | TB, lymphoma |
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