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200
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Anatomy

Upper Limb

Question 155 of 239

You are asked to assess a 32 year old woman who presents with a five day history of fever and right arm swelling following a cat scratch. On examination you note she has supratrochlear lymphadenopathy. Regarding the supratrochlear lymph nodes, which one of the following statements is INCORRECT:

Answer:

The supratrochlear lymph nodes lie subcutaneously above the medial epicondyle, medial to the basilic vein. They drain the ulnar side of the forearm and the medial hand. Differential diagnosis for enlarged lymph nodes includes skin infections, skin malignancies and lymphoma.

Supratrochlear and Infraclavicular Lymph Nodes

Anatomy / Upper Limb / Anterior Arm

Last Updated: 8th April 2019

Supratrochlear Lymph Nodes

The supratrochlear lymph nodes lie subcutaneously above the medial epicondyle, medial to the basilic vein. They drain the ulnar side of the forearm and the medial hand. Differential diagnosis for enlarged lymph nodes includes skin infections, skin malignancies and lymphoma.

Infraclavicular Lymph Nodes

The 2 - 3 infraclavicular (deltopectoral) lymph nodes lie in the deltopectoral groove inferior to the clavicle, located superiorly and posteriorly to the axillary artery. They primarily drain the radial side of the upper limb. Lymphadenopathy here is highly suspicious for non-Hodgkin's lymphoma specifically, and for malignancy in general.

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Lymphatic Drainage of the Arm. Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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