Mondor disease (breast)

Last revised by Mostafa Elfeky on 19 Aug 2023

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

  • dehydration

  • 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.

The veins most commonly involved are the thoracoepigastric, lateral thoracic, and superior epigastric veins.

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.

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.

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.

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