Chyle leak (CL) secondary to inadvertent thoracic duct (TD) injury is an exceptionally rare complication of a right hemithyroidectomy, as the terminal TD typically terminates in the left side of the neck.[1,2,3] Anatomical variations of the terminal TD are well renowned, and a right sided terminal TD has been previously described.[2,4] We present a 72-year-old male with bilateral large thyroid goitre associated with chronic dyspnoea and dysphagia. Following assessment, he was planned for a total thyroidectomy, however, due to intraoperative difficulties, he underwent a right hemithyroidectomy only. Four days later, he re-presented with neck swelling and breathlessness. Re-explorative surgery identified serosanguinous fluid which tested positive for chylomicrons, confirming a chyle leak, likely from a right sided terminal TD. Generally, he responded well to conservative management.

Patient data was collected through the hospital's digital patient records system. A literature search was conducted using the databases Google Scholar and PubMed.

Our literature search identified that up to 1.3% of the humans have a right sided TD.[2] The incidence of TDI tends to increase with the extent of the neck procedure performed.[3] Although a few cases have reported CL following right sided neck dissection, to our knowledge, this is the first study to describe a CL following a right hemithyroidectomy alone.

Complex anatomical variations of the TD exist and thus CL should be well-recognised as a differential diagnosis of neck swelling following both left- and right-sided neck surgeries. Head and neck surgeons should consider consenting patients undergoing right sided neck surgeries for a CL.