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

BACKGROUND

Chyle leaks are a rare but recognized complication of neck surgery, most commonly encountered on the left due to thoracic duct (TD) anatomy.

OBSERVATIONS: The authors present an unusual case of a right-sided chyle leak encountered during brachial plexus exposure for nerve transfer for right hemidiaphragm paralysis. Intraoperatively, a moderate leak of milky fluid was identified near a lymph node bed and controlled with suture ligation. Postoperative recovery was uneventful. Right-sided occurrence suggests variant lymphatic anatomy, possibly involving an accessory TD or a large right lymphatic channel.

LESSONS: Although uncommon, right-sided chyle leaks may occur during supraclavicular dissection. Awareness of potential anatomical variations, meticulous intraoperative inspection, and prompt recognition allow immediate management and prevention of postoperative morbidity. This case highlights the need for heightened vigilance for lymphatic injury even during nononcological neck procedures. https://thejns.org/doi/10.3171/CASE26349.