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Case Report

Mondor Disease of the Breast

Iacob Marcovici, MD

Mondor disease is usually a benign and self-limiting process, but it may be associated with breast cancer and hypercoagulability.

Mondor disease of the breast is a rare condition characterized by thrombophlebitis of the superficial veins. It is seldom reported, perhaps due to lack of awareness. In most cases it is benign and self-limiting. However, as this condition has also been reported in association with breast cancer and hypercoagulability disorders, it is important to perform radiologic and laboratory studies before proceeding with reassurance and conservative treatment.

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CASE REPORT

A 29-year-old woman presented with complaints of left breast pain. On examination a single, tender, 4-cm vein could be palpated extending from the areolar margin toward the axilla. The clinical diagnosis was superficial thrombophlebitis. This was confirmed on Doppler ultrasonography, which revealed a subdermal tubular area in the left breast with no blood flow (Figure). Laboratory investigation excluded hypercoagulability. Based on experience with superficial thrombophlebitis of the hands/arms that sometimes follows prolonged intravenous therapy, the patient was successfully treated with oral antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and warm compresses. Ultrasonographic findings obtained 4 weeks later were normal.

Figure not available online

Figure 1. Spectral Doppler ultrasonography showing absence of blood flow in the superficial vein of the left breast. Courtesy of Iacob Marcovici, MD.

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DISCUSSION

Mondor disease of the breast is a rare, self-limiting condition characterized by thrombophlebitis of the subcutaneous veins of the anterolateral thoracoabdominal wall. The most common clinical manifestations are a painful subcutaneous “cord” corresponding to the affected vessel, skin redness, and edema. Breast ultrasonography shows a superficial vessel without blood flow on Doppler imaging, and with or without an intraluminal thrombus (Figure). Together with a mammographic finding of a tubular density, this is the typical sign of this disorder.1

The etiology of Mondor disease is not clear. In 51% of cases, it is associated with breast surgery involving injury to the subcutaneous chest veins.2 Mondor disease has also been noted following stereotactic, vacuum-assisted breast biopsy.3 In addition, it has been reported in association with hereditary protein C and anticardiolipin antibodies, protein S deficiency, jellyfish sting, pregnancy, subclavian vein catheterization, lung cancer metastatic to the breast, and bilateral axillary node biopsy.4-10 Plastic surgeons report no apparent relationship between Mondor disease and silicon breast implants or capsule contracture.11 Breast clinic data from 9,657 patients demonstrated Mondor disease in 84 (<1%); among the affect- ed women, the incidence of breast cancer was 2.3%.2 This is in contrast with other authors findings that cite an incidence of 12.7%.12

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CONCLUSION

In most cases, Mondor disease of the breast will resolve with antibiotic/NSAID therapy and topical measures. However, due to the possibility of associated breast cancer or hypercoagulable states, physical examination and laboratory studies should be performed to exclude a more serious underlying disorder.

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Iacob Marcovici, MD, is director, Department of Obstetrics and Gynecology, Women’s Health Center, Bristol Hospital, Connecticut; and assistant professor, Department of Obstetrics and Gynecology, Yale University, New Haven, Conn, and University of Connecticut, Farmington.

References

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3. Harris AT. MondorÍs disease of the breast can also occur after a sonography-guided core biopsy. AJR Am J Roentgenol. 2003;180(1): 284-285.
4. Wester JP, Kuenen BC, Meuwissen OJ, de Maat CE. MondorÍs disease as first thrombotic event in hereditary protein C deficiency and anticardiolipin antibodies. Neth J Med. 1997;50(2):85-87.
5. de Godoy JM, Godoy MF, Batigalia F, Braile DM. The association of MondorÍs disease with protein S deficiency: case report and review of literature. J Thromb Thrombolysis. 2002;13(3):187-189.
6. Duff P. Mondor disease in pregnancy. Obstet Gynecol. 1981;58(1): 117-119.
7. Draghi F, Calliada F, Bottinelli O, Pallavicini D, Sommaruga MG. MondorÍs disease secondary to subclavian vein catheterization. Report of a case [in Italian]. Radiol Med (Torino). 1999;97(1-2):92-93.
8. Ingram DM, Sheiner HJ, Ginsberg AM. MondorÍs disease of the breast resulting from jellyfish sting. Med J Aust. 1992;157(11-12):836-837.
9. Courtney SP, Polacarz S, Raftery AT. MondorÍs disease associated with metastatic lung cancer in the breast. Postgrad Med J. 1989;65(768):779-780.
10. Bauerfeind I, Himsl I, Ruehl I. MondorÍs disease after bilateral axillary node biopsy. Arch Gynecol Obstet. 2006;273(6):374-377.
11. Green RA, Dowden RV. MondorÍs disease in plastic surgery patients. Ann Plast Surg. 1988;20(3): 231-235.
12. Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A. MondorÍs disease and breast cancer. Cancer. 1992;69(9): 2267-2270.

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