Mondor’s Disease?

Mondor's disease is uncommon. it is characterised by acute thrombophlebitis of the superficial veins of the breast, neck, upper limbs, penis, and anterior chest wall.1 Mondor’s disease is most common among women between 30 to 60 years, with an incidence rate of 0.5% and 0.8% amongst breast cancer patients.3

The diagnosis of the disease is based on the location of the symptoms. In most cases, the condition rapidly develops as a painful red cord-like structure under the skin, which later becomes less painful; however, the fibrous band formed persists. Therefore, the pain only occurs in the disease’s early stages, which later becomes painless. 

The disease is self-limiting, meaning that it tends to go away on its own. This usually occurs by re-cannulation, followed by a resolution of symptoms.3 However, because the disease is rare, its causes are not well studied, which makes management unclear.4 

Furthermore, because Mondor’s disease is self-limiting, there have only been 400 reported disease causes in medical literature.5 In addition, there has been no correlation between Mondor’s disease and ethnicity, race, and age. 

Therefore, as the disease is isolated, case studies have been conducted to determine the cause and management. This case study focuses on a patient who has developed Mondor’s disease on the right arm in the area between the arm and the forearm, scientifically known as the antecubital fossa, following chemotherapy for breast cancer.4 

Risk factors for Mondor’s disease 

Several risk factors can increase the likelihood of developing Mondor’s disease, such as strenuous exercise, especially with bodybuilders. Other causes include: 

  • Direct injury linked with surgery
  • Directly damaging the veins
  • Blood stagnation
  • External pressure on the veins. 

There have also been reports that breast cancer and COVID-19 can lead to the development of Mondor’s disease.6,7

Diagnosis 

There are several ways to diagnose Mondor’s disease. First, a physical examination can be conducted on patients; if this is not enough, a further ultrasound scan is done to confirm the condition. For example, if a patient presents with a painful red cord-like structure on the breast, a breast X-ray or ultrasound is carried out to confirm the condition.8 

In addition, a Magnetic Resonance Angiography (MRA) can also be used, which will reveal a clearer picture of the venous system. Finally, biopsies are also a good way of diagnosing the disease and ruling out other diagnoses.9

The case study

The study involved a 36-year-old female diagnosed with right breast cancer after undergoing several extensive tests, including a mammoplasty. She then underwent chemotherapy with several drugs (Cyclophosphamide, Epirubicin and Taxol). After completing her second chemotherapy cycle, she experienced a low white blood cell count (neutropenia) which caused a delay in the subsequent four cycles of chemotherapy she was supposed to receive. 

Seven months later, the examinations showed three painful band-like cords at her antecubital fossa along the length of the arms underneath the skin. Although these bands could be felt and were uncomfortable, they did not cause any restrictions on the movement of the right elbow. The clinical findings were characteristic of Mondor’s disease affecting the arm, possibly due to previous chemotherapy.4 

Management 

The management of the condition was conservative; she was advised to apply nonsteroidal anti-inflammatory gel. The patient was also advised to massage the antecubital fossa area daily. As the patient had no restrictions to elbow movement or severe pain, physiotherapy was not required to manage the disease.

Two months after the treatment regimen was introduced to the patient, it resulted in the partial resolution of the formed fibrous bands. In addition, the bands became less painful and softer; therefore, the patient was advised to continue massaging the bands indefinitely. In addition, it was said that the bands had no adverse effect on the patient's arm function at any point.

Furthermore, the use of non-steroidal anti-inflammatory drugs, other treatments such as anticoagulation therapytriamcinolone injections, and surgery in extreme cases are also used to manage the condition.10 Follow-up after treatment is necessary, as there is a small risk of the disease developing into deep vein thrombosis.11 

Summary

Mondor’s disease is a rare disease that affects women more than men. It is a self-limiting condition and can be treated with nonsteroidal anti-inflammatory drugs along with other measures if necessary. 

However, surgical intervention might be required if the case is severe enough to limit joint movement. Despite the use of anti-inflammatory drugs, it is also essential to follow up with ultrasound scans to ensure these bands are no longer visible and prevent any further complications.

References 

  1. Suganthan N, Ratnasamy V. Mondor’s disease – a rare cause of chest pain: a case report. Journal of Medical Case Reports. 2018;12(1). 
  2. Mondor H: Tronculite sous-cutanée subaiguë de la paroi thoraccique antero-laterale. Mem Acad Chir. 1939, 65:1271-1278. 
  3. Pasta V, D’Orazi V, Sottile D, Del Vecchio L, Panunzi A, Urciuoli P: Breast Mondor’s disease: diagnosis and management of six new cases of this underestimated pathology. Phlebology. 2015, 30:564-568. 
  4. Monib S, Chong K. Mondor's Disease of the Arm Following Breast Cancer Treatment. 2022. 
  5. Quéhé P, Saliou AH, Guias B, Bressollette L: Mondor's disease, report on three cases and literature review. (Article in French). J Mal Vasc. 2009, 34:54-60. 
  6. Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor's disease of the chest wall. Phys Ther Sport. 2017 Jan;23:133-135. 
  7. Goldman A, Wollina U. Mondor's Disease after Aesthetic Breast Surgery: A Case Series and Literature Review. J Cutan Aesthet Surg. 2018 Jul-Sep;11(3):132-135.
  8. Benign breast conditions: Mondor's disease [Internet]. Breast Cancer Now. 2022 [cited 21 May 2022]. Available from: https://breastcancernow.org/information-support/have-i-got-breast-cancer/breast-pain-other-benign-conditions/mondor’s-disease#main-content 
  9. Amano and Shimizu, 2018 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191595/#__ffn_sectitle 
  10. O’Neal JM, Castleberg E, Dinh VAN: Diagnosis of Mondor’s disease in the emergency department with bedside ultrasound. Case Rep Emerg Med. 2015, 2015:817960. 
  11. Rountree KM, Barazi H, Aulick NF: Mondor Disease. StatPearls Publishing, Treasure Island, FL; 2020.

Hyperlinks 

  1. https://www.mayoclinic.org/diseases-conditions/thrombophlebitis/diagnosis-treatment/drc-20354613 
  2. https://teachmesurgery.com/skills/clinical/cannulation/ 
  3. https://teachmeanatomy.info/upper-limb/areas/cubital-fossa/ 
  4. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/magnetic-resonance-angiography-mra 
  5. https://www.drugs.com/drug-class/topical-non-steroidal-anti-inflammatories.html 
  6. https://www.nhs.uk/conditions/anticoagulants/ 
  7. https://www.mayoclinic.org/drugs-supplements/triamcinolone-injection-route/description/drg-20074674 
  8. https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Murielle Nsiela

MSc Graduate in Medical Engineering - Bachelor's degree, Pharmaceutical Science, Keele University, Staffordshire UK

MSc in Medical Engineering Design, Keele University Modules included: Advanced engineering applications, Engineering for medical applications report, Bioreactors and Growth environment, Creative engineering design, Experimental research methodology and research projects



BSc (Hons) Pharmaceutical Science, Technology and Business, Keele University Modules included: Core topics in pharmaceutical science, Laboratory studies - tabletting and liposomes report, applied Pharmaceutical Science 2, Pharmaceutical research project

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