A 74-year-old woman presented with a lump in the right neck of four weeks’ duration. She had previously had squamous cell carcinoma of the left floor of the mouth and underwent ablative and reconstructive surgery, including neck dissection of the left side, 10 years ago. Ultrasound and fine-needle aspiration of this lump revealed a diagnosis of metastatic squamous cell carcinoma. As a consequence, the patient had selective neck dissection (level 1–4) of the right hand side on this occasion. A posterior tributary was seen draining the IJV arising from under the SCM joining the antero-inferior aspect of the lower-third of the IJV.