Mondor’s Disease

A 44-year-old white female with no significant past medical history presented with a three-day history of mild tenderness of the left anterolateral thoracoabdominal wall. Twenty-three days earlier, she underwent an excision for a 6-mm nodular basal cell carcinoma of the left submammary area. Physical examination revealed three tender subcutaneous cord-like indurations without erythema that began below the well-healed surgical scar and continued toward the left lower quadrant of the abdomen [Figure 1]. Lifting the left arm above the head accentuated the appearance of the cords. Doppler ultrasonography revealed two noncompressible venous structures in the superficial subcutaneous tissues extending inferiorly over a length of a few centimeters, suggesting occlusive thrombi within small superficial veins just inferior to the surgical site. She was treated with nonsteroidal anti-inflammatory drugs and had a full recovery within seven weeks after presentation.

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Figure 1

Mondor’s disease. Three cord-like indurations on the anterolateral thoracoabdominal wall

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DISCUSSION

Mondor’s disease (MD) was first described by Henri Mondor in 1939 as a superficial thrombophlebitis of a vein in the anterolateral thoracoabdominal wall. It is typically benign and self-limited, usually resolving in four to eight weeks without any specific treatment.[1] MD occurs most commonly in middle-aged women, with a female-to-male ratio ranging from 9:1–14:1.[1] No racial or ethnic propensity has been reported. The diagnosis is straightforward and based on physical examination. In cases where the clinical picture is not definitive, ultrasound is considered first-line treatment in the imaging evaluation of MD. The differential diagnosis includes thrombophlebitis migrans, infectious mastitis, Buerger disease, Behcet disease, and polyarteritis nodosa.[2] Forty-five percent of cases are idiopathic, 20% iatrogenic (including surgical chest operation, radiation, and hormone therapy), 22% traumatic (excessive physical activity and tight bra), and 5% related to breast cancer. Other risk factors include a hypercoagulable state and vascular disease. Nonsteroidal anti-inflammatory drugs can be used to relieve bothersome symptoms. Low-molecular-weight heparin or aspirin is not recommended in patients without underlying hypercoagulable state inciting superficial thrombophlebitis and associated MD.[2] The accurate identification of MD is important to first evaluate for the presence of underlying disease and to avoid performing any unnecessary invasive tests or treatment.