Mondor’s Disease

Clinical History: A 47-year-old female patient complaining from tender mass in upper outer left breast. Clinically cord-like structures were palpable in the upper outer quadrant of her left breast.

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Figure 1

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Figure 2

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Figure 3

Finding: Craniocaudal (Fig. A) and mediolateral oblique (B) mammograms show superficial tubular densities. Breast ultrasound scan (Fig. C) showed a long, superficial, beaded, tubular, hypoechoic structure in the left breast at 3 o’ clock position. Additionally noted low-level echoes were seen within it. It measured 5 mm in its widest diameter and showed no flow on color by spectral Doppler study.

Diagnosis: Left breast upper outer subcutaneous thrombophlebitis (Mondor’s disease)

Discussion: Mondor’s disease of the breast is a benign, self-limiting condition; characterized by thrombophlebitis of the superficial veins of the mammary region (1). Direct trauma and pressure on the superficial veins of the breast leading to stasis has been postulated in the etiopathogenesis of the disease. Breast biopsy and surgery, trauma, infection and breast cancer are risk factors (2).

It commonly affects middle-aged women. Mammogram showed a superficial tubular density in the affected side. The Breast Imaging Reporting and Data System assessment was category 3 for these cases. A short-interval follow-up in six months was recommended.

Mondor's disease presents as a palpable cord or mass in the breast sometimes with pain. Sonographic and mammographic evaluations are indicated in patients with suspected Mondor’s disease. Finding a dilated tubular density may potentially be mistaken for a dilated duct. Mondor’s disease is managed conservatively with treatment of pain using anti inflammatory and analgesic drugs. Biopsy, anticoagulants and antibiotics are unnecessary (3).

References:
1. Pugh CM, DeWitty RL. Mondor’s disease. J Natl Med Assoc 1996;:359–63.
2. Bejanga BI. Mondor’s disease: analysis of 30 cases. J R Coll Surg Edinb 1992;:322–4.
3. Shetty MK, Watson AB. Mondor’s disease of the breast: sonographic and mammographic findings. AJR Am J Roentgenol 2001;:893–6.

Doaa Ibrahim, MD, in radio-diagnosis, Zagazig University Hospitals and TechnoScan Centers in Egypt