Apical axillary nodes !

The apical axillary nodes sit at the top of the armpit under the collarbone; all the lymph of the arm and much of the breast passes through them.

See in 3D →

Opens in the Durgical app, no sign-up needed.

What it is

Nodes at the apex of the armpit, above and medial to pectoralis minor, along the axillary vein (level III).

What it does

Receive all the other axillary groups (and the infraclavicular nodes); their outflow forms the subclavian lymph trunk.

Key facts

Where: Apex of the axilla, medial and superior to pectoralis minor, along the axillary vein (level III)
Drains: All other axillary groups; infraclavicular nodes; upper breast
Into: Subclavian lymph trunk -> thoracic duct (left) or right lymphatic duct / venous angle

Relations

Course: Efferents join into the subclavian lymph trunk, which runs with the subclavian vein to the junction of the internal jugular and subclavian veins (right) or to the thoracic duct (left)
In front: Clavipectoral fascia and pectoralis major; the end of the cephalic vein, the thoracoacromial vessels and the lateral pectoral nerve cross this plane
Lateral: The axillary vein, then the axillary artery and the cords of the brachial plexus
Medial: The first intercostal space and the first digitation of serratus anterior
Above: Clavicle and subclavius; beyond them, the supraclavicular nodes at the root of the neck

How to find it

Usually not palpable. With the arm relaxed, the examiner pushes the fingertips as high as possible into the axilla toward the clavicle; ultrasound, CT or PET-CT assess them for staging.

Common problems

Cancer here (level III) is more advanced and can spread on to the nodes above the clavicle.

How it is diagnosed

Examination of the armpit and ultrasound with a needle biopsy; in breast cancer, the sentinel node is found with a tracer during surgery.

Treatment

Sentinel node biopsy: only the first one to three nodes are removed and checked.
Axillary dissection (levels I–II) or radiotherapy when the nodes contain cancer; arm swelling (lymphoedema) is the main risk.

Clinical notes

Level III disease places a breast cancer in a higher nodal stage than involvement of level I or II alone
Surgically hard to reach because of the pectoral nerves and the end of the cephalic vein; clearing them may need pectoralis minor to be retracted or divided
Spread beyond them reaches the supraclavicular nodes, which may then be felt above the clavicle

Breast cancer

Test yourself

Think of the answer, then tap the question to see it.

Where are the apical axillary nodes and which surgical level are they?

At the apex of the axilla, medial to pectoralis minor and in front of the axillary vein, behind the clavipectoral fascia: level III.

What vessel do the efferents of the apical nodes form and where does it end?

The subclavian lymph trunk, ending in the venous angle on the right or the thoracic duct on the left.

Why are the apical axillary nodes hard to reach in surgery?

They lie high behind pectoralis minor and the clavipectoral fascia, among the pectoral nerves and the end of the cephalic vein.

Add to my cards (3)

Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): nodi axillares apicales TA2 5237
Official Spanish (DeCS): Nódulos linfáticos axilares apicales
English (TA2): Apical axillary nodes
Also called: subclavian nodes

Sources: Terminologia Anatomica (TA2); Anatomía humana (4.ª ed.), tomo 1, cap. 61: Vasos y ganglios linfáticos del miembro superior; Anatomy, Shoulder and Upper Limb, Axillary Lymph Nodes.

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.