A 19-year-old man was admitted with a left supraclavicular mass that had been present for three days, and had started two days after undergoing vigorous massage of the neck by a professional masseur. The mass had increased progressively in size over the ensuing three days prior to attendance at the hospital, but there were no other relevant symptoms, and specifically no dyspnoea or dysphagia. On physical examination, there was a 6 x 5 x 6 cm painless and fluctuant mass in the left supraclavicular fossa, overlapping the sternocleidomastoid muscle anteriorly, and no coexisting adenopathy or additional neck mass. Ultrasonography of the neck revealed a fluid mass suggesting a venous haemorrhage within the neck musculature, whereas magnetic resonance imaging (MRI) demonstrated a 6 x 5.5 x 6 cm cystic mass located in the supraclavicular region between the carotid artery and internal jugular vein (figure 1). Percutaneous needle aspiration was performed, and the aspirate found to be milky macroscopically. Biochemical analysis of the fluid revealed the following: cholesterol 90 mg/dl, triglycerides 2400 mg/dl, and white blood cell count 3200 cells/mm3 (80% lymphocytes).