MONDOR DISEASE
Mondor disease, or superficial angiitis, is a superficial thrombophlebitis of the breast, named after Henri Mondor (1885-1962), a French surgeon who first described the disease in 1939. This is a very uncommon clinical entity that may occur during the late reproductive or early menopausal years. The predominant age for patients with Mondor disease is between 30 and 60 years. This should not be confused with Paget-Schroetter disease, which refers to deep vein thrombosis of an upper extremity vein, including the axillary or subclavian vein often following vigorous activity (though it can also occur spontaneously).
Breast phlebitis is most often linked
to a recent pregnancy, trauma, or operative procedure but may occur
spontaneously. It most often involves the thoracoepigastric veins of the breast
and the lateral thoracic veins. Rarely, Mondor can present following
augmentation mammoplasty, manifesting as temporary cords extending from below
the breast toward the abdomen. This occurs in less than 2% of patients. In
these patients, the cords appear at about 3 to 6 weeks, last a few months, and
then usually disappear.
Thrombophlebitis of the breast veins
usually presents with symptoms of pain that is acute and generally located in
the upper outer quadrant of the breast. Dim- pling of the skin or a distinct
cord with erythematous margins may be found on physical examination. In
addition, a shallow groove may be seen extending upward toward the axilla when
the arm is raised.
Although these symptoms are typical
of Mondor disease, they must be differentiated from those of a breast abscess
or mastitis, ductal ectasia, carcinoma, or fat necrosis. Mondor disease can be
distinguished from inflammatory cancer of the breast by the presence of sudden
pain, early skin adherence, and progressive improvement, characteristics that
are not present in these cancers. Scarring from previous surgery (biopsy,
augmentation, or reduction) can result in thickening or a retraction of the
overlying skin, similar to that seen in Mondor disease but should be readily
distinguished by careful history.
Mondor disease is generally
diagnosed by history and physical examination. On physical examination there
will be accentuation of dimpling, or the formation of a groove over the
affected vein. This often occurs when the ipsilateral arm is raised during
physical examination. Mammography may be required to rule out other processes,
but the diagnosis is generally established by physical examination and history.
(On mammography, a beaded subcutaneous vein may be seen together with skin
retraction. Rarely, the vein calcifies.) On ultrasonography, a tubular,
hypoechoic structure corresponding to the
thrombosed vein may be seen. In rare patients, a biopsy may be required to establish
the diagnosis.
Mondor disease is benign and
self-limited. The treatment of superficial thrombophlebitis of the breast is
generally supportive: analgesics and heat reduces symptoms. The condition
generally clears up on its own in 2 to 3 weeks, but it may take 6 weeks or
longer to completely resolve. Although there is generally no restriction on physical activity, good
mechanical support with a well-fitting bra or binder improves comfort during
vigorous activity. Antibiotics and anticoagulants have little effect on the
course of the disease and are not indicated.
Subcutaneous penile vein thrombosis
(penile Mondor disease) has also been described. It appears suddenly as almost
painless indurations on the penile dorsal surface. Its pathogenesis is unknown.
