{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T14:31:50Z","timestamp":1760711510720,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,4,20]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Chyle leak (CL) secondary to inadvertent thoracic duct injury (TDI) is an exceptionally rare complication of a right hemithyroidectomy. TDI occurs in 0.5\u20131.4% of patients undergoing a thyroidectomy, and of those, only one-fourth are attained following right-sided neck surgeries, as the terminal thoracic duct (TD) typically terminates in the left side of the neck. Anatomical variations of the terminal TD are well renowned, and a right-sided terminal TD has been previously described. Although CL following right-sided neck dissection has been described in the literature, to our knowledge, this is the third case to describe a CL following a right hemithyroidectomy alone.<\/jats:p>\n               <jats:p>We present a man in his 70s who was referred to endocrinology with a persistently low T4 on a background of normal Thyroid Stimulating Hormone(TSH). Incidentally, he was found to have a bilateral large goitre associated with chronic dyspnoea and dysphagia. 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 later tested positive for chylomicrons, confirming a CL, likely from a right-sided terminal TD. Generally, he demonstrated a good response to conservative treatment.<\/jats:p>\n               <jats:p>Complex anatomical variations of the TD exist and thus CL should be well-recognised as a differential diagnosis of neck swelling following both left-sided neck and right-sided neck surgeries. Head and neck surgeons should consider consenting patients undergoing right-sided neck surgeries for a CL.<\/jats:p>","DOI":"10.1136\/bcr-2024-260298","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T23:45:13Z","timestamp":1749599113000},"page":"e260298","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Chyle leak as a cause of neck swelling following a right hemithyroidectomy for multinodular goitre"],"prefix":"10.1136","volume":"18","author":[{"given":"Tania","family":"Sarsam","sequence":"first","affiliation":[{"name":"ENT, Royal Sussex County Hospital, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Kassab","sequence":"additional","affiliation":[{"name":"Trinity Health - Ann Arbor, Ypsilanti, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Watts","sequence":"additional","affiliation":[{"name":"ENT, Royal Sussex County Hospital, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"2025082712421501000_18.6.e260298.1","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/8362874","article-title":"Management of chyle leak after head and neck surgery: review of current treatment strategies","volume":"2017","author":"Delaney","year":"2017","journal-title":"Int J Otolaryngol"},{"key":"2025082712421501000_18.6.e260298.2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijscr.2017.11.031","article-title":"Surgical intervention in a complicated persistent chyle leak","volume":"42","author":"Tenny","year":"2018","journal-title":"Int J Surg Case Rep"},{"key":"2025082712421501000_18.6.e260298.3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.rmed.2019.08.014","article-title":"Clinical approach and review of causes of a chylothorax","volume":"157","author":"Riley","year":"2019","journal-title":"Respir Med"},{"key":"2025082712421501000_18.6.e260298.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/joa.12811","article-title":"The anatomy and physiology of the terminal thoracic duct and ostial valve in health and disease: potential implications for intervention","volume":"233","author":"Ratnayake","year":"2018","journal-title":"J Anat"},{"key":"2025082712421501000_18.6.e260298.5","unstructured":"Bojanapu S . Thoracic duct leak. StatPearls; 2023."},{"key":"2025082712421501000_18.6.e260298.6","first-page":"205","article-title":"Anatomical variations of the thoracic duct: a preliminary report in adult and fetal specimens","volume":"49","author":"Amore","year":"2016","journal-title":"Lymphology"},{"key":"2025082712421501000_18.6.e260298.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.otpol.2014.03.003"},{"key":"2025082712421501000_18.6.e260298.8","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2010.25.4.541"},{"key":"2025082712421501000_18.6.e260298.9","doi-asserted-by":"crossref","first-page":"142S","DOI":"10.1177\/01455613221121495","article-title":"Neck swelling 19 days after thyroidectomy: a case report of a rare chyle leak patient","volume":"104","author":"Pan","year":"2025","journal-title":"Ear Nose Throat J"},{"key":"2025082712421501000_18.6.e260298.10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.11604\/pamj.2021.40.209.30496","article-title":"Management of chyle leak in right side neck dissection: a rare case and review of literature (a case report)","volume":"40","author":"Deshmukh","year":"2021","journal-title":"Pan Afr Med J"},{"key":"2025082712421501000_18.6.e260298.11","doi-asserted-by":"publisher","DOI":"10.1002\/aja.1000170203"},{"key":"2025082712421501000_18.6.e260298.12","doi-asserted-by":"crossref","first-page":"76","DOI":"10.5005\/jp-journals-10002-1175","article-title":"Conservative management of Chyle leak following thyroid surgery","volume":"7","author":"Chekavar","year":"2015","journal-title":"World Journal of Endocrine Surgery"},{"key":"2025082712421501000_18.6.e260298.13","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/S0266-4356(98)90533-2","article-title":"A morphological study of the thoracic duct at the jugulo-subclavian junction","volume":"36","author":"Langford","year":"1998","journal-title":"British Journal of Oral and Maxillofacial Surgery"},{"key":"2025082712421501000_18.6.e260298.14","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1017\/S0022215112002939","article-title":"The surgical anatomy and clinical relevance of the neglected right lymphatic duct: review","volume":"127","author":"Smith","year":"2013","journal-title":"J Laryngol Otol"},{"key":"2025082712421501000_18.6.e260298.15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijscr.2017.03.003","article-title":"Life threatening presentation of thoracic duct injury post thyroid surgery; a case report","volume":"34","author":"Halawani","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"2025082712421501000_18.6.e260298.16","unstructured":"Lyden M . Surgical anatomy of the thyroid gland. 2023."},{"key":"2025082712421501000_18.6.e260298.17","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s40463-016-0166-y","article-title":"Chylothorax in thyroid surgery: a very rare case and systematic review of the literature","volume":"45","author":"Merki","year":"2016","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"2025082712421501000_18.6.e260298.18","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1177\/014556130308200721","article-title":"Left cervical chyloma following right thyroidectomy","volume":"82","author":"Madnani","year":"2003","journal-title":"Ear Nose Throat J"},{"key":"2025082712421501000_18.6.e260298.19","doi-asserted-by":"crossref","DOI":"10.1136\/bcr.02.2012.5747","article-title":"A rare complication: lymphocele following a re-operative right thyroid lobectomy for multinodular goitre","volume":"2012","author":"Touska","year":"2012","journal-title":"BMJ Case Rep"},{"key":"2025082712421501000_18.6.e260298.20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.14740\/jmc3811","article-title":"Iatrogenic thoracic duct injury via the right internal jugular vein: a case report","volume":"13","author":"Kono","year":"2022","journal-title":"J Med Cases"},{"key":"2025082712421501000_18.6.e260298.21","first-page":"67","article-title":"Recalcitrant Hypocalcemia: Postsurgical Hypoparathyroidism Exacerbated by a Chyle Leak Treated With Octreotide","volume":"10","author":"Dorcely","year":"2024","journal-title":"AACE Clin Case Rep"},{"key":"2025082712421501000_18.6.e260298.22","first-page":"437","article-title":"Octreotide for treating chylothorax after cardiac surgery","volume":"32","author":"Kilic","year":"2005","journal-title":"Tex Heart Inst J"},{"key":"2025082712421501000_18.6.e260298.23","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13143379","article-title":"Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer","volume":"13","author":"Bove","year":"2021","journal-title":"Cancers (Basel)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-260298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:42:37Z","timestamp":1756323757000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-260298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,10]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2024-260298"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-260298","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}