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.

An unusual presentation of penile Mondor's disease in an HIV-positive patient

Penile Mondor's disease (PMD), or thrombosis of the dorsal vein, is an under-reported benign condition. Its aetiology is poorly understood. Clinically, it presents as a palpable cord in the dorsal vein of the penis, with pain or local discomfort, especially during erection. PMD may be diagnosed based on the medical history and physical examination. Management of the condition is conservative, with practitioners opting for various strategies including sexual/masturbatory abstinence, localised anticoagulant topical therapy and oral nonsteroidal anti-inflammatory drugs. In many cases, PMD will resolve within 4-8 weeks of presentation. Thrombectomy and resection of the superficial penile vein are applied surgically in patients refractory to the medical treatment. We describe the case of a 33-year-old patient known to have HIV who presented for severe painful dorsal induration and swelling of the proximal third of the penis. The patient had no recent history of sexual intercourse, penile trauma or other well-known risk factors for PMD. The physical examination was unequivocal, so a Doppler ultrasound was performed. A diagnosis of PMD was made and conservative treatment was prescribed. During a follow-up visit after 6 weeks, the patient had no symptoms and physical examination did not reveal anything pathological.

Exercise-Induced Mondor's Disease of the Chest Wall in a Nigerian Man: A Case Report

BACKGROUND

Mondor's disease (MD) is a rare cause of chest pain, characterized by thrombophlebitis of the subcutaneous veins of the anterolateral thoracoabdominal wall. It is a benign, self-limiting condition that is often underdiagnosed due to lack of knowledge of the condition. Although the exact aetiology is unclear, several predisposing factors, including excessive physical activity have been postulated. To the best of our knowledge, there is no previous published report of MD of the chest wall in an adult Nigerian man.

OBJECTIVE

To describe the association between muscular strain and the development of MD.

CASE PRESENTATION

A 40-year-old Nigerian man presented with a one-month history of dull, aching right-sided chest pain. He gave a history of engaging in intense thoracoabdominal exercises for 6 weeks prior to onset of symptoms. Physical examination revealed a tender, subcutaneous cord-like swelling extending from below the right anterior axillary fold to the right hypochondrium and accentuated by overhead abduction of the right arm. Ultrasonography revealed a hypoechoic, noncompressible right thoracoepigastric vein with no flow on Doppler interrogation, in keeping with superficial venous thrombosis. He was treated with nonsteroidal anti-inflammatory agents and paracetamol. The pain and lesion resolved completely within two weeks after presentation and there was no recurrence over the subsequent four months of follow-up.

CONCLUSION

MD is an uncommon cause of chest pain that is often underdiagnosed and underreported due to lack of awareness. It can suddenly appear in persons performing extreme thoracoabdominal exercises. Treatment is essentially symptomatic. Prompt diagnosis of this self-limiting condition is essential in distinguishing it from malignant diseases.

Superficial Thrombophlebitis of the Penis following AstraZeneca ChAdOx1-S Vaccination: A Rare Venous Thromboembolic Complication

Penile Mondor’s disease is a rare condition characterised by superficial thrombophlebitis of the penis which is usually self-limiting. The cause is often unknown. The AstraZeneca ChAdOx1-S vaccine has been found to cause a hypercoagulable state, which is well documented. This case report describes a man who presented with Mondor’s disease following ChAdOx1-S vaccination with no other risk factors.

Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program

Background

Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery.

Methods

This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS.

Results

There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12–11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36–31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS.

Conclusions

A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.

Mondor's disease of the breast: a case series

BACKGROUND

Mondor's disease of the breast (MDB) is a rare and benign disorder of the breast. It is characterized by thrombophlebitis of the superficial veins of the chest wall. Clinically, it manifests as a cord-like induration of the breast area. MDB resolves spontaneously without sequela.

CASE PRESENTATION

We report cases of three Caucasian African patients aged 29, 40 and 34, respectively. One patient was under progestative contraception. All the patients had a cord-like induration on the chest wall. Ultrasonography was performed in all patients and was normal in two cases and showed a thrombotic vein in one case. All the patients had symptomatic treatment with total resolution of symptoms within 1 to 4 weeks. No relapse was observed.

CONCLUSION

MDB is benign in most cases. However, it is not to be taken lightly, because it can be the manifestation of an underlying disease such as breast cancer. The diagnosis is based on clinical findings; ultrasonography can be helpful for the diagnosis. Treatment is based on analgesic and anti-inflammatory drugs.

Superficial Thrombophlebitis of the Breast (Mondor's Disease): An Uncommon Localization of Common Disease

Mondor's disease (MD), or superficial thrombophlebitis of the anterolateral thoracoabdominal wall, is a rare disease that presents with a palpable cord-like induration beneath the skin. It is a benign, self-limiting condition with probably underestimated significance due to the fact it may be a rare manifestation of an underlying breast carcinoma. It can also resemble breast malignancy and, if physician is not familiar with clinical features of MD, it may lead to unnecessary biopsy. The diagnosis is straightforward in most cases and it may be based on a thorough history and physical examination and it can be ultrasonographically confirmed. Raising awareness of this condition may facilitate recognition and diagnosing MD and eventually limit unnecessary diagnostic procedures.

Mondor's Disease in SARS-CoV-2 Infection: A Case of Superficial Vein Thrombosis in the Era of COVID-19

SARS-CoV-2 causes blood hypercoagulability and severe inflammation resulting in an increased risk of thrombosis. Consequently, COVID-19 patients with cardiovascular disease seem to be at higher risk of adverse events. Mondor's disease is a rare, generally self-limiting, thrombosis of the penis. The pathogenesis of Mondor's disease is unknown, and it is usually diagnosed through clinical signs and with Doppler ultrasound evaluation. We describe the case of a young man with COVID-19 infection who manifested Mondor's disease.

LEARNING POINTS

SARS-CoV-2 infection is associated with an inflammatory response leading to a prothrombotic state and subsequent risk of arterial and venous pathology.Superficial vein thrombosis can occur in COVID-19 patients.

Recurrent Mondor's breast disease -- Hormonal contraceptive involvement

Mondor's disease can be a challenging diagnosis. The case we present is of a 29 year-old Brazilian woman, under combined hormonal contraception, who consulted for a painful lump on her right breast. She presented a complete resolution after a local treatment of heparinoid cream and a non-steroidal anti-inflammatory oral treatment, but relapsed 18 months later. Oral combined hormonal contraception was the only "risk factor" found, in this case, and the modification of the latter helped resolve the relapse clinical symptoms.

Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies

Axillary web syndrome (AWS) is a common condition occurring in up to 86% of patients following breast cancer surgery with ipsilateral lymphadenectomy of one or more nodes. AWS presents as a single cord or multiple thin cords in the subcutaneous tissues of the ipsilateral axilla. The cords may extend variable distances "down" the ipsilateral arm and/or chest wall. The cords frequently result in painful shoulder abduction and limited shoulder range of motion. AWS most frequently becomes symptomatic between 2 and 8 weeks postoperatively but can also develop and recur months to years after surgery. Education about and increased awareness of AWS should be promoted for patients and caregivers. Assessments for AWS should be performed on a regular basis following breast cancer surgery especially if there has been associated lymphadenectomy. Physical therapy, which consists of manual therapy, exercise, education, and other rehabilitation modalities to improve range of motion and decrease pain, is recommended in the treatment of AWS.

Mondor's disease - a rare cause of chest pain: a case report

BACKGROUND

Chest pain is one of the common presenting symptoms encountered in an emergency department. Prompt history taking and careful clinical examination do help to differentiate cardiac chest pain from other causes. Mondor's disease is a rare cause of chest pain which is often underdiagnosed due to lack of awareness. Mondor's disease is a condition characterized by thrombophlebitis of the superficial veins of breast and anterior chest wall. The diagnosis is often made clinically.

CASE PRESENTATION

Here we report a case of a 37-year-old Sri Lankan Tamil woman who presented with chest pain and was clinically diagnosed as having Mondor's disease after a physical examination, which was confirmed with demonstration of thrombophlebitis by ultrasound scan imaging. Although it is a self-limiting condition, non-steroidal anti-inflammatory drugs are used in the treatment to hasten recovery in addition to giving reassurance.

CONCLUSIONS

Mondor's disease is not considered a differential diagnosis for chest pain due to lack of awareness of this medical condition. Creating awareness of this condition via this case would help to cut down unnecessary investigations and valuable time spent in emergency departments, and it helps to identify a serious underlying cause especially carcinoma of the breast at its early stage.

Mondor's Disease after Aesthetic Breast Surgery: A Case Series and Literature Review

Background:

Mondor’s disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor’s disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer.

Materials and Methods:

This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years.

Results:

We found three cases of Mondor’s disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2–3 weeks.

Conclusion:

Mondor’s disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: a Case Report

BACKGROUND

In the context of breast cancer, axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery. This painful condition, likely lymphofibrotic in origin, restricts upper extremity range of motion (ROM). There is no established treatment, although physical therapy and other approaches have been used to variable effect. This report describes treatment of a female client with AWS, who had recently undergone a unilateral simple mastectomy with sentinel node biopsy plus axillary dissection.

METHODS

The client presented with pain upon movement (self-reported as 5 on the 0-10 Oxford Pain Scale), visible cording and restricted use of the ipsilateral upper extremity. Clinical assessment included determining the extent of AWS cording (taut, from axilla to wrist) and measuring glenohumeral joint ROM (140° flexion by goniometer). A therapeutic massage with movement protocol, termed dynamic angular petrissage, was administered over two sessions: Swedish massage combined with dynamically taking the limb through all possible angles of movement (passive ROM), controlling stretch and tension while simultaneously and segmentally applying petrissage and non-petrissage techniques to the underlying soft tissue. Careful attention was taken to not break the cord. Home care consisted of prescribed exercises performed by the patient.

RESULTS

After Session One, pain was reduced (to 0/10), ROM improved (to 170° flexion), and cording was visibly reduced. After Session Two the cord was residually apparent only on hyperextension, with no ROM restrictions in glenohumeral joint flexion. Follow-up at three months revealed absence of visual or palpable evidence of cording, unrestricted glenohumeral joint ROM, and absence of movement-associated pain.

CONCLUSION

The signs and symptoms of AWS were quickly and effectively eliminated, without causing any pain or discomfort to the client. We propose that dynamic angular petrissage may be an efficient and safe treatment approach for reducing the pain, mobility restrictions, and cording of AWS.

Breast Mondor's disease: Diagnosis and management of six new cases of this underestimated pathology

Mondor's disease is an unusual and little-known pathology of the breast, characterized by superficial thrombophlebitis. The causes are still unresolved. Most of the patients do not fall under case studies of the scientific literature, given the reported incidence rate between 0.5% and 0.8%. The Mondor's disease patients are not always properly identified, and they are frequently treated as outpatients, even considering the benign course of the disease which often spontaneously resolves without any medical therapy. We report here six new cases of Mondor's disease, two of them were likely due to a trauma and were easily resolved with the use of non-steroidal anti-inflammatory drugs; the third one was apparently due to the stretching of the mammary veins in a patient with gigantomastia; the fourth one was subsequent to hormonal stimulation for in vivo fertilization and following gestation; and the last two cases (one was a man) were diagnosed after undergoing surgery for breast carcinoma.

Tight Bra in a 34-Year-Old Woman: An Unusual Cause of Mondor's Disease

Mondor's disease is characterized by thrombophlebitis of the superficial veins of the breast and the chest wall. The list of causes is long. Various types of clothing, mainly tight bras and girdles, have been postulated as causes. We report a case of a 34-year-old woman who referred typical symptoms and signs of Mondor's disease, without other possible risk factors, and showed the cutaneous findings of the tight bra. Therefore, after distinguishing benign causes of Mondor's disease from hidden malignant causes, the clinicians should consider this clinical entity.

Tight Bra in a 34-Year-Old Woman: An Unusual Cause of Mondor's Disease

Mondor's disease is characterized by thrombophlebitis of the superficial veins of the breast and the chest wall. The list of causes is long. Various types of clothing, mainly tight bras and girdles, have been postulated as causes. We report a case of a 34-year-old woman who referred typical symptoms and signs of Mondor's disease, without other possible risk factors, and showed the cutaneous findings of the tight bra. Therefore, after distinguishing benign causes of Mondor's disease from hidden malignant causes, the clinicians should consider this clinical entity.

Atypical penile Mondor's disease - involvement of the circumflex vein

Mondor's disease is a rare condition characterised by superficial thrombophlebitis of subcutaneous veins, most commonly over the anterior chest wall. Penile Mondor's disease is rarer, arising out of thrombophlebitis of the penile veins. It typically involves the dorsal vein of the penis and presents with a cord-like indurated lesion with a beaded feel, palpable along the length of the involved vein. Though penile Mondor's disease involving the dorsal vein of the penis has been reported by many authors, we report a peculiar case of penile Mondor's disease in a 26-year-old sexually active man with thrombophlebitis of the circumflex vein of the penis with sparing of the dorsal vein. Diagnosis was confirmed on Doppler ultrasonography of the penile venous system. Despite exhaustive history taking, no cause could be elicited. The lesion completely subsided within three days with daily local hot fomentation. We propose the term 'atypical penile Mondor's disease' for such a case.

Role of ultrasonography with color-Doppler in diagnosis of penile Mondor's disease

Penile Mondor's disease (superficial thrombophlebitis of the penis dorsal vein) is an uncommon and benign pathology that affects sexually active men. Although the diagnosis is made by physical examination in most patients, sonography may be required in some cases. Color-Doppler ultrasonography clearly visualizes dorsal vein thrombosis and the associated hemodynamic alterations. We describe the symptoms, the sonographic findings and treatment of this disease in a 26-year-old male with superficial thrombophlebitis of the penis dorsal vein.