Mondor's disease of the breast: a case series

Breast Pain Differential: Mondor's Disease of the Breast

Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor's disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor's disease often resolves spontaneously with supportive care, as in this patient's case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.

Changes to breast structure and function across a woman's lifespan: Implications for managing and modeling female breast injuries

BACKGROUND

Female breasts change throughout a woman's life in response to fluctuating hormonal influences. Individuals managing active women and those modeling female breasts must understand these structural and functional changes across a female's lifespan because these changes affect breast injuries sustained by women.

METHODS

We initially review female breast structure and function and then describe how breast structure changes across a woman's lifespan. Key studies about direct contact and frictional breast injuries are then summarized. Limitations of current breast injury research, gaps in knowledge about breast injuries incurred by specific populations, and the lack of breast injury models are also highlighted.

FINDINGS

With minimal anatomical protection, it is unsurprising that breast injuries occur. Although research about breast injuries is scant, direct contact during blunt force trauma to the anterior chest wall and frictional breast injuries have been reported. There is a lack, however, of research documenting the incidence and severity of breast injuries incurred in occupational settings and in women's sports. Therefore, to design effective breast protective equipment, we recommend research to model and investigate the mechanisms and forces involved in breast injuries, particularly injuries sustained during sport.

INTERPRETATION

This unique review summarizes how female breasts change over a woman's life span, with implications for breast injuries sustained by females. Knowledge gaps about female breast injuries are highlighted. We conclude by recommending research required to develop evidence-based strategies to improve how we classify, prevent, and clinically manage breast injuries sustained by females.

SUMMARY

We review changes to the breast across a woman's lifespan, highlighting implications for managing and modeling female breast injuries.

Mondor's disease of the breast: A cutaneous thromboembolic manifestation of Covid-19?

BACKGROUND

Mondor's disease is a rare disorder characterised by thrombosis of superficial veins within the subcutaneous tissue of the breast and other organs. While factors such as trauma, infection, physical exertion, breast cancer and breast surgery have been implicated, in the majority no cause is identified.

PATIENTS

Twenty patients presented with a clinical diagnosis of Mondor's disease to the Edinburgh Breast Services in 2020. We present the etiopathogenic data as well as clinical and imaging diagnostic findings.

RESULTS

During 2020, the annual incidence of Mondor's disease, in the UK's largest breast unit, increased five-fold compared to data from the previous year. This variation in the frequency of cases corresponded to trends in the frequency of Covid-19 infection during the pandemic. None of the patients had diagnosed COVID and few had any known etiopathogenic causes for their Mondor's.

CONCLUSION

Several recent studies have provided evidence for links between Covid-19 and thromboembolic events. Isolated reports have proposed a link between Covid-19 and Mondor's disease of the penis. Here we present data on a large series of Mondor's disease of the breast supporting a link between breast Mondor's and Covid-19.

Diagnosis of Mondor's Disease in the Setting of Right-Sided Anterior Chest Wall Pain

A 60-year-old male patient presented to the emergency department of our hospital with right-sided chest wall pain and a palpable subcutaneous cord-like structure along the right anterior chest wall. Examination revealed tenderness over the cord-like structure, and the skin overlying the structure was freely mobile and did not have any sign of infection or inflammation. Bedside ultrasonography revealed an uncompressible tubular structure with the absence of a color Doppler flow signal. The patient's presentation was suggestive of Mondor's disease. The patient was discharged with instructions to utilize anti-inflammatory drugs, perform warm compresses, and seek primary care follow-up to ensure resolution. Mondor's disease is a rare disorder characterized by a superficial thrombophlebitis of the subcutaneous veins of the chest wall. For its diagnosis, a thorough examination of the patient's medical history and physical condition is suggested; further, the performance of point-of-care ultrasonography has also been suggested. Once recognized, further emergency department workup is typically unnecessary in cases of primary Mondor's disease. Despite being a mostly self-limited condition, greater awareness of this rare disease entity is required to ensure and coordinate close outpatient follow-up as well as monitor resolution due to its association with secondary causes such as vascular and breast carcinoma, vasculitis, and hypercoagulable disorders.