A 48-year-old woman with a retrojugular lymph node in left side of neck on follow-up ultrasound (US) after total thyroidectomy for papillary thyroid carcinoma (4.1 × 5.3 × 5.5 mm). The retrojugular lymph node was diagnosed as ‘lymph node metastasis from papillary thyroid carcinoma’ in cytology after US-FNA, and the patient underwent radioisotope therapy without neck surgery. A. Perpendicular puncture: a spot away from the lateral wall of the internal jugular vein. B. Lateral angulation of the syringe-needle unit (the echogenic line (arrows) indicates the needle shaft and tip). C. A successful puncture of the target after an appropriate approach of the syringe-needle unit (the echogenic line (arrows) indicates the needle shaft and tip). D. Drawings illustrating how to approach a lymph node located in the retrojugular area. Initially, the needle is perpendicularly inserted at the periphery of the internal jugular vein (left). The syringe-needle unit is then angled and the needle tip is wedged into the lesion (middle and right).