Right-sided chyle leak encountered during supraclavicular brachial plexus exposure: illustrative case

Area of Science:

• Neurosurgery
• Vascular Anatomy
• Surgical Complications

Background:

• Chyle leaks are rare complications of neck surgery, typically occurring on the left due to thoracic duct anatomy.
• Right-sided chyle leaks are exceptionally uncommon, suggesting potential variations in lymphatic drainage.
• Identifying and managing these leaks is critical to prevent significant postoperative morbidity.

Purpose of the Study:

• To report an unusual case of a right-sided chyle leak during supraclavicular neck dissection.
• To highlight the importance of recognizing anatomical variations in lymphatic structures.
• To emphasize prompt intraoperative management to prevent complications.

Main Methods:

• A case of right-sided chyle leak during brachial plexus surgery for right hemidiaphragm paralysis is presented.
• Intraoperative identification of a milky fluid leak near a lymph node bed.
• Suture ligation was used for immediate control of the chyle leak.

Main Results:

• The patient experienced an uneventful postoperative recovery following surgical management of the chyle leak.
• The right-sided occurrence suggests possible variant lymphatic anatomy, such as an accessory thoracic duct or a prominent right lymphatic channel.
• No significant complications were noted post-procedure.

Conclusions:

• Right-sided chyle leaks can occur during supraclavicular dissections, even in nononcological procedures.
• Awareness of potential lymphatic anatomical variations is essential for surgeons.
• Meticulous intraoperative inspection and prompt recognition are key to successful management and prevention of morbidity.