A 31-year-old man comes to the emergency department complaining of right-sided scrotal pain and swelling that has gradually worsened over the last 3 days. His temperature is 38.3 C (101 F). On physical examination, his right hemiscrotum is warm, tender, and erythematous. The cremasteric reflex is present. A scrotal ultrasound reveals a fluid collection consistent with a superficial scrotal abscess. Which of the following lymph node groups is most likely to be tender and swollen?

Question

A 31-year-old man comes to the emergency department complaining of right-sided scrotal pain and swelling that has gradually worsened over the last 3 days.  His temperature is 38.3 C (101 F).  On physical examination, his right hemiscrotum is warm, tender, and erythematous.  The cremasteric reflex is present.  A scrotal ultrasound reveals a fluid collection consistent with a superficial scrotal abscess.  Which of the following lymph node groups is most likely to be tender and swollen?

Quizplus · Accepted Answer

11ec160b_358f_5555_9249_bffe8e8c8bce_MD0001_00 Lymphatic drainage of the scrotum occurs via the superficial inguinal lymph nodes. These lymph nodes drain nearly all cutaneous lymph from the umbilicus to the feet, including the external genitalia and anus (up to the dentate line). The exceptions are the testis, glans penis, and the cutaneous portion of the posterior calf. Lymph from the testes drains directly into the para-aortic (retroperitoneal) lymph nodes (Choice D). Lymph from the glans penis and the cutaneous portion of the posterior calf drains into the deep inguinal lymph nodes. The superficial inguinal lymph nodes also drain into the deep inguinal lymph nodes. (Choice A) The common iliac nodes are located alongside the common iliac artery and drain the internal and external iliac nodes. The external iliac nodes receive lymph from the deep inguinal lymph nodes. (Choice B) The inferior mesenteric nodes drain the structures supplied by branches of the inferior mesenteric artery (eg, the left colic, sigmoid, and superior rectal arteries). Thus, these nodes drain the descending and sigmoid colon as well as the upper part of the rectum, and their efferents drain into the pre-aortic nodes. (Choice C) Infraclavicular lymph nodes are found beside the cephalic vein between the pectoralis major and deltoid, immediately below the clavicle. They drain lymph from portions of the upper limb and breast. Educational objective: Due to its intra-abdominal origin, lymphatic drainage of the testis is to the para-aortic lymph nodes. In contrast, lymph drainage from the scrotum goes into the superficial inguinal lymph nodes.

A 31-Year-Old Man Comes to the Emergency Department Complaining of Right-Sided