Currently, there are only 2 previously published case reports in the literature which describe vagus nerve duplication at various levels. We present a case report of a rare and undescribed variant of vagus nerve anatomy in conjunction with management of a paediatric patient with thymopharyngeal cyst. 6-year-old male presented with an asymptomatic left sided neck mass on a background of nil previous medical history or upper aerodigestive symptoms. It was a level 4 mass in the left neck which was firm, solid and non-tender. Further workup found a benign cystic mass consistent with an inflammatory process. After a routine curvilinear incision, microdissection found the cyst to be wrapped in 2 identical nervous tissue structures at level 2 of the neck which joined into 1 superiorly at the root of the neck. This was concluded to be a vagal nerve duplication which was carefully dissected off the cyst. Nerve function was preserved post op. Previously the vagus nerve has been described to have a highly reliable and fixed anatomic course within the carotid sheath. This is starting to be challenged by literature studies reporting atleast one third of the vagus nerves branching within the sheath in a large cadaveric study. Other differential diagnosis of a duplicated nerve include non-recurrent laryngeal nerve, aberrant cervical sympathetic chain or the aberrant root of ansa cervicalis. These however are not explained by the visualised rejoining of the nervous structures at the root of the neck and continuing in the fixed course of the vagus nerve cranially. Our case highlights the importance of preoperative work up including imaging, histology and multidisciplinary discussions with relevant specialties for rarely seen pathologies. It also highlights the need for further vagus nerve anatomical variants to be published in literature to act as a benchmark for a large cadaveric study to understand this complex course in more detail.