“Tension Chyle Leak”: A Life‐Threatening Sequela of Thoracic Duct Injury Following Resection of BRAF ‐Mutated Anaplastic Thyroid Carcinoma

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Abstract
Background: Airway obstruction secondary to chyle leak is an exceptionally rare phenomenon. Here, we describe this complication in a patient with anaplastic thyroid carcinoma (ATC) undergoing consolidative surgery after BRAF‐targeted therapy. Methods: A 55‐year‐old man presented with a rapidly enlarging neck mass. Work‐up was consistent with metastatic unresectable BRAF V600E ‐mutant ATC. After a remarkable response to neoadjuvant dabrafenib and trametinib, he underwent curative‐intent surgery with a right hemithyroidectomy and bilateral neck dissection. Within 48 h, he developed an expanding left neck mass with laryngeal obstruction due to a chyle leak. Results: Despite surgical repair and maximal medical therapy, the leak persisted necessitating thoracoscopic ligation of the thoracic duct. Final pathology showed a completely excised residual tumor. The patient remains disease‐free on long‐term dabrafenib and trametinib. Conclusions: BRAF‐directed therapy has transformed the care of patients with mutated ATC. As more patients undergo consolidative surgery, increased vigilance is paramount in minimizing complications and their associated morbidity.

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