1302 Chyle Leak as a Cause of Neck Swelling Following a Right Hemithyroidectomy for Multinodular Goitre: A Case Report

Background Chyle leak (cl) secondary to inadvertent thoracic duct injury (tdi) is an exceptionally rare complication of a right hemithyroidectomy.1 tdi occurs in 0.5-1.4% of patients undergoing a thyroidectomy, 1and of those, only one fourthare attained following right sided neck surgeries,2as the terminal thoracic duct (td) typically terminates in the left side of the neck.3,4,5 anatomical variations of the terminal td are well renowned, and a right sided terminal td has been previously described. 4,6 although a few cases have reported cl following right sided neck dissection, to ourknowledge, this is the first study to describe a cl following a right hemithyroidectomy alone. Case report We present a 72-year-old gentleman who was referred to endocrinology with a persistently low t4 on a background of normal tsh. Incidentally, he was found to have a bilateral large thyroid 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 chyle leak, likely from a right sided terminal td. Generally, he demonstrated a good response to conservative treatment. Conclusions 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.