Monday, September 8, 2008

Mondor's Disease

Mondor's disease is an uncommon condition of the pectoral region. Fage (2nd reference) first described this condition in 1870, but in 1939 it was characterized by Henry Mondor.

It is a benign condition. (photo credit)

It is manifest by thrombophlebitis of the superifical veins of the thoracic and abdominal walls (lateral thoracic, thoracoepigastric, and superior epigastric veins).

These superficial veins are painful, string-like subcutaneous cords on and around the breast. Occasionally there may be redness along the cord. The cord may be between 3-5 mm in diameter and 5-30 mm in length.

One or more or the above mentioned veins may be involved.

Involvement of the upper inner portions of the breast have never been described.

The etiology is not known.

Female to male ratio is 3:1. Most patients are in the 30-60 yr age range. The incidence rate after open surgical biopsy is less than 1%. Usually unilateral, but may be bilateral.

The condition subsides spontaneously after a few weeks. The time course is reported to be between 2 weeks and a few months. A fibrous cord may be evident for as long as a year.

Back to the etiology:

Most cases have no clear precipitating event and the exact pathogenesis remains unclear. The disease may be intiated by trauma, infection, or surgery. If there is no feasible reason for Mondor's disease (ie recent surgery, infection, use of breast veins for IV drug use), then a mammogram should be done to rule out any cancerous lesions. The coincidence of Mondor's disease and breast cancer has reported to be up to 12 percent in a series of 63 such patients.

Treatment is conservative.

  • Local heat application
  • Anti-inflammatories
  • Reassurance
  • In the absence of infection, antibiotic therapy is not warranted

REFERENCES

MONDORS DISEASE: An Unusual Complication of Mammoplasty; Plastic & Reconstructive Surgery. 56(3):319-322, September 1975; Fischl, Robert A MD; Kahn, Sidney MD; Simon, Bernard E MD

Mondor's Disease after Breast Reduction Surgery; Plastic & Reconstructive Surgery. 117(7):129e-132e, June 2006; Loos, Bernd M.D.; Horch, Raymund E. M.D.

Mondor Disease; eMedicine Article, Apr 30, 2008; Robert Schwartz, MD and Matthew Trovato, MD

Mondor's Disease of the Breast; AJR 2001; 177:893-896; Mahesh K Shetty and Alfred B Watson

Remarks on certain cutaneous affections; Guys Hosp Rep (3rd series) 1869;15:295 -302; Faage CH. (did not read, but found the reference in the above articles)

Tronculite sous-cutanee subaique de la paroi thoracique antero-laterale; Mem. Acad. Chir.1271, 1939; Mondor, H. (did not read, but found the reference in the articles above)

Phlebite en cordon de paroi thoracique; Mem Acad Chir, 70:96-98, 1944; Mondor, H (did not read, but found the reference in the articles above)

9 comments:

Bongi said...

i've only seen it once. i didn't know what it was at the time.

Anonymous said...

I just went to a surgeon today for this. I am a 43 year old male. Thanks for the information. It was very helpful!

Nils said...

Had a patient with this in my office today. Guessed it was some sort of phlebitis because of tenderness, and a quick google gave the diagnosis. Internet is our friend :-)

Anonymous said...

I was given the diagnosis a month ago. While I am a "text book case", I was a bit concerned by the size of the structure (from armpit to hip with branching)and the fact that I had none of the typical cause factors. I also had a clear mammogram only 5 months before. A current mammogram did reveal an adenofibroma, requiring a biopsy. I don't have those results yet, but will in a couple of days. I've seen so many MDs in the past month, the surgeon is next for the 2nd opinion (really the 3rd or 4th) to help decide the next course of action.

Michela said...

In 2008, I start feeling breast pain, tenderness and with time it seemed like my veins were swollen. I did 4 mammographies, the doctor told me that it was something she had never seen but she was going to study, I never got a explanation for what I had. Doctor suggested a biopsy. After more than I year I looked for another doctor. Only yesterday, I was diagnosis Mondor's disease. The more I read on the Internet the more I get curious. Unfortunately, there's not much about...I am scared.

Anonymous said...

My post may be more than yra older than Nils, but goy to agree him that "Internet is our friend :-)". I saw a 35 yr old male patient (my barber) with superficial chest pain on 7th September 2011. He came back later, stating that the pain was still there, now he could feel something that wasn't there when he had come. Indeed I could palpate a strikingly cord like structure starting from the lt. lateral apex of the pect muscle, transcending the chest above the niple down to the epigastric area at a point midway between the umbilicus and the xyphiod process. My first guess was....is is witchcraft since we are in Africa??? But I was suspicious it could be vacular given the course of the cord but still wasn't sure. A surgeon hinted about the thrombophlebitis, googled it in my own, the came up with Mondor's disease....and the treatmemnt I gave was what is generally recommended. Thanks to the internet.

mwood said...

I have never had surgery and no trauma and yet I have what clearly appears to be Mondor's. My doctor and radiologist are "absolutely perplexed" as they can't clearly see it on the mammo or ultrasound. They also sent me for an MRI and only found a calcification that needs to be monitored. Although mondor's appears to just go away, I am a bit freaked as to why I have it for no reason! When I lift my arm above my head it looks like someone is taking a string and pressing it all the way across my breast. :( It is so unattractive and annoying! At nights it feels like it is going to rip out of my chest!!! I wish someone could give me answers and not just be "fascinated" when they see it.

KD said...

I also have been recently diagnosed with Mondor's Disease. I have had no surgeries or injuries. I've had ultra sound, abdomen cat scan, and numerous blood tests. These cords are multiplying and branching. I now have cords on my right chest wall wrapping down past liver and around my back,there are cords on my left side, going around my back also, and it feels like there are some of these in my gut too. I also feel this in my thigh also. The pain is a 10 at times, sending me to bed. I have no life. All the recommendations of the dr's for pain relief doesn't work. I am unable to function. They are active,they grow on and off and when active my voice is unrecognizable due to, I think, the internal swelling. I am disgusted with the medical profession for not doing more research on this. This has been escalating and going on for months. Pain all the time. Reassurance, hot, cold,ansaids do not work! I'm trying to find something to stop the progression of this. I do believe this will kill me if I don't get help. Drs basically know nothing about what causes this.

JD said...

KD, I know this is more than a year after your post, but it would be good to hear how your condition evolved.
It seems like my wife has this too, although not in such an extent. The cords grow on and off, she's had 6 or 7 under her left breast, then they disappeared and only 1 stayed, now she has 4 or 5 of them.. They're not too long, around 2-3 cm (1 inch), she feels a slight pain, more pain when pressed, and when she raises her arm she has a feeling of tension where the cords are. She hasn't had any surgeries or traumas, but recently took some hormones for fertility stimulation. She sometimes feels what she describes as pain in the veins in her legs. The doctors can't figure out what these cords are, I only found it on the Internet and from what I saw, it looks exactly like Mondor's disease.