Mondor’s disease : rare case of a painful breast lump in a middle-aged woman

• Published in: Sultan Qaboos University medical journal 2017-05, Vol.17 (2), p.244-245
• Main Authors: Michael, Philips Jurj, Jamkhandikar, Rakesh, al-Sadi, Tahirah
• Format: Article
• Language: English
• Subjects: Breast - blood supply; Breast - diagnostic imaging; Breast cancer; Breasts; Female; Humans; Interesting Medical Image; Mammography; Mastodynia - etiology; Middle Aged; Thrombosis; Ultrasonography, Mammary; Veins & arteries; Venous Thrombosis - diagnostic imaging; الثدي; داء موندور; دراسات الحالة
• ISSN: 2075-051X; 2075-0528
• DOI: 10.18295/squmj.2016.17.02.021

Colour Doppler ultrasonography of both breasts of a 52-year-old postmenopausal female showing flow in some of the superficial veins (arrow) and intraluminal thrombosis with no flow in a few of the others (arrowheads). Comment With an incidence of approximately 0.5–0.8%, Mondor’s disease is a very rare benign condition characterised by thrombophlebitis of the subcutaneous veins of the chest wall.1,2 The disease is named after Henri Mondor, a French surgeon, who first reported it in 1939.3 In most cases, the condition is idiopathic; however, it can be associated with a previous history of breast-related trauma, surgical procedures, biopsies or central venous catheter insertion.4 A few cases have reported an association with breast cancer, although as yet no direct relationship has been established.1,4 In cases where the underlying aetiology is not obvious, patients with Mondor’s disease should be investigated to determine the cause of the disease, if possible, and to exclude breast cancer, lymphatic spread from a carcinoma, a hypercoagulable state or connective tissue disease.2,4 Recognition and differentiation of this rare condition from a breast abscess or malignancy is also essential.4 On mammography, thrombosed veins observed in cases of Mondor’s disease are superficial, tubular and beaded cord-like densities which correspond to the clinically palpable and tender cord-like breast lumps.1,2 However, it is important to avoid mistaking superficial thrombosed veins for dilated ducts during imaging.1 In contrast, the thrombosed veins appear on ultrasonography as superficially located long tubular anechoic non-compressible structures interrupted by narrowed areas, giving them a beaded appearance, most commonly located in the upper outer aspect of the breast, unlike dilated ducts.1 Moreover, a thrombosed vein at a periareolar location does not terminate at the areola and bilaterality is rare in Mondor’s disease.1 In their evaluation of imaging findings in Mondor’s disease, Yanik et al. concluded that colour Doppler ultrasonography can help in establishing a correct diagnosis as well as monitoring resolution after treatment.5 Similar findings were also noted by Adeniji-Sofoluwe et al.6 A clot may be seen as an intraluminal filling defect within the dilated superficial veins with no flow on colour or spectral Doppler studies.1,5,6 After a diagnosis of Mondor’s disease has been made from initial mammographic and sonographic findings, a short-interval imaging follo