Mondor disease (breast)
Citation, DOI & article data
Mondor disease is a rare benign breast condition characterized by thrombophlebitis of the subcutaneous veins of the breast and anterior chest wall. It can also occur in the axilla, when it is called axillary web syndrome, or the penis.
Although Mondor disease is rarely reported in the literature, this is likely in part due to a lack of awareness of the entity. It tends to dominate in women between 30-60 years.
Incidence rates of 0.5-0.8% have been reported, however, it reflects only the symptomatic population.
In most patients (50-60% 12), the condition is idiopathic 4. Recognized associations include:
- trauma, preceding thoracic or breast surgical procedures, ultrasound-guided or stereotactic biopsies
- previous central venous catheters
- hypercoagulable states
- although an association with breast cancer (~12% 2) has been reported, the veracity of this claim is difficult to confirm due to the over-representation of patients being investigated for other breast lesions in reported cases 1
Patients usually present with a painful breast (cord-like) mass. There may be overlying skin erythema. It may be accentuated when the ipsilateral arm is raised.
The pathogenesis includes the formation of venous thrombosis with total or partial occlusion and vascular recanalization causing fibromuscular hyperplasia of the vessel wall and infiltration plus fibrosis of surrounding subcutaneous cellular tissue. The thrombotic vessel can adhere to the superjacent skin causing retraction and formation of characteristic cordiform grooves secondary to local fibroblastic proliferation.
Location - distribution
- it most commonly affects the thoracoepigastric and/or lateral thoracic veins towards the upper outer quadrant; the upper inner quadrants of the breasts are almost never involved 6.
- less commonly, penile Mondor disease or axillary web syndrome are seen
Typically, Mondor disease appears as superficially located tubular beaded density corresponding to a palpable rope-like mass. Mammography is normal in a significant proportion of cases.
On ultrasound, Mondor disease appears as a tubular anechoic or isoechoic structure with multiple areas of narrowing, giving a beaded appearance. Sometimes low-level internal echoes may be present representing clot. The surrounding soft tissues may be hyperechoic due to the associated inflammatory response.
No flow is present on color or spectral Doppler studies and in some situations, an abrupt cut off with the normal vessel may be seen.
Treatment and prognosis
It is a benign self-limiting condition, and the natural history is for the thrombosed vein to recanalize and for clinical symptoms to resolve gradually (~6 weeks). Anti-inflammatory medications, e.g. NSAIDs, are sometimes given for symptomatic relief.
Otherwise, management is supportive, and routine anticoagulants, antibiotics or surgical intervention are not indicated due to the thrombophlebitis subsiding spontaneously and without complications, or persistent deformity. Systemic anticoagulants are occasionally given to high risk patients 8.
A close interval follow-up scan is usually recommended to ensure resolution and to exclude any other entity.
History and etymology
In the year 1869, Faage was the first one to describe this condition 10,11. Further characterization of this condition by the French surgeon Henri Mondor (1885-1962) was published in 1939, hence the eponym.
Interestingly Mondor is now more remembered for his biographies, than his surgical exploits. His subjects were both biomedical (Louis Pasteur, Guillaume Dupuytren, and René Leriche) and literary (French poets Stéphane Mallarmé and Paul Valéry) 7.
- 1. Shetty MK, Watson AB. Mondor's disease of the breast: sonographic and mammographic findings. AJR Am J Roentgenol. 2001;177 (4): 893-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Sabaté JM, Clotet M, Gómez A et-al. Radiologic evaluation of uncommon inflammatory and reactive breast disorders. Radiographics. 25 (2): 411-24. doi:10.1148/rg.252045077 - Pubmed citation
- 3. Conant EF, Wilkes AN, Mendelson EB et-al. Superficial thrombophlebitis of the breast (Mondor's disease): mammographic findings. AJR Am J Roentgenol. 1993;160 (6): 1201-3. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Conant EF, Brennecke CM. Breast imaging, case review. Mosby Inc. (2006) ISBN:0323017460. Read it at Google Books - Find it at Amazon
- 5. Cardeñosa G. Clinical breast imaging, a patient focused teaching file. Lippincott Williams & Wilkins. (2006) ISBN:0781762677. Read it at Google Books - Find it at Amazon
- 6. Paredes ES. Atlas of mammography. Lippincott Williams & Wilkins. (2007) ISBN:0781764335. Read it at Google Books - Find it at Amazon
- 7. Kyle R & Shampo M. Henri Mondor: Biographer and Surgeon. Mayo Clin Proc. 1986;61(7):563. doi:10.1016/s0025-6196(12)62005-9
- 8. Suganthan N & Ratnasamy V. Mondor's Disease - a Rare Cause of Chest Pain: A Case Report. J Med Case Rep. 2018;12(1):4. doi:10.1186/s13256-017-1530-x - Pubmed
- 9. Bastos Mendes J, Ferreira Gomes J, Rovisco Branquinho L, Oliveira Carvalho C, Pacheco Mendes P, Carvalho Madaleno J. Mondor's Disease: A Rare Cause of Chest Pain. Eur J Case Rep Intern Med. 2020;7(12):001984. doi:10.12890/2020_001984 - Pubmed
- 10. Amano M & Shimizu T. Mondor's Disease: A Review of the Literature. Intern Med. 2018;57(18):2607-12. doi:10.2169/internalmedicine.0495-17 - Pubmed
- 11. Faage CH. Remarks on certain cutaneous affections. Guys Hosp Rep (3rd series) 1869; 15:295-302
- 12. Ben Hamida K, Ghalleb M, Triki A, Jebir I, Makhlouf R, Touinsi H. Mondor’s Disease of the Breast: A Case Series. J Med Case Reports. 2021;15(1):188. doi:10.1186/s13256-021-02708-6 - Pubmed