Mondor's disease

Assessment of clinical conditions associated with Mondor disease

BACKGROUND

Mondor disease is superficial thrombophlebitis of the thoracoabdominal wall, mid-upper arm, and penis. Although it is usually a benign disease requiring no specific treatment, little is known about this disease owing to its rarity.

OBJECTIVE

The aim of this retrospective observational study was to investigate the epidemiology and prognosis of Mondor disease.

METHODS

We conducted a single-center observational study of patients with Mondor disease. Patients who received a diagnosis of Mondor disease between 2015 and 2020 were analyzed. The patients' medical records were manually reviewed to obtain the following variables: date of diagnosis, patient's age, sex, department of diagnosing physicians, underlying diseases, medications, surgery, and time until resolution of the lesion. We also reviewed the 1-year mortality, 1-year occurrence of malignancy, and recurrence of Mondor disease.

RESULTS

20 patients were included in the study. The age of the patients ranged from 7 to 83 years, with a median of 47.5 years. Most of the patients presented with thoracoabdominal wall lesions. The underlying conditions included skin diseases, surgical procedures, breast cancer, smoking, and collagenous diseases, although more than half of the patients did not have plausible predisposing factors. About three-quarters of the patients saw a spontaneous resolution of the lesions within 4 weeks without medical or surgical treatments.

CONCLUSIONS

Considering the good prognosis of this disease, it is essential to avoid unnecessary invasive tests or treatment once the diagnosis is confirmed.

Mondor’s Disease: A Rare Cause of Chest Pain

Mondor’s disease is an uncommon cause of breast and chest pain. It is characterized by cord-like thickening of the superficial veins of the anterior chest wall mimicking many life-threatening illnesses such as pulmonary thromboembolism and myocardial infarction. The disease may have been caused by trauma, other hypercoagulable states, or underlying breast diseases such as infection or carcinoma breast, but, in most cases, its etiology remains unknown. Mondor’s disease is usually self-limited and can be managed conservatively. Although a rare and benign diagnosis, Mondor’s disease should be a part of the differentials of chest pain, and its diagnosis can be made on the basis of a thorough clinical examination alone, which reduces not only costs but also the risks of further testing for patients presenting with chest pain.

We highlight the case of a 40-year-old premenopausal female patient who presented to the outpatient department with stretching aching chest pain on the left side, which got aggravated on movements of the arm and relieved on rest.

Mondor’s disease is not considered a differential diagnosis for chest pain due to a lack of awareness about it. Creating awareness of this condition through this case report would help to reduce unnecessary investigations and valuable time spent and would help identify a serious underlying cause, especially early stage carcinoma of the breast.

Penile Mondor's in a Covid-19 patient on prophylactic anti-thrombosis with rivaroxaban: a case report

Background

Penile Mondor's disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment.

Case Presentation

A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD's onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week.

Conclusion

Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.

Mondor's Disease of the Arm Following Breast Cancer Treatment

Mondor's disease is a rare, peculiar form of superficial thrombophlebitis which mainly affects the subcutaneous veins of the breast, anterior chest wall, neck, axilla, upper limbs and penis.

In most cases, it presents with rapid development of a painful subcutaneous cord-like structure that later becomes less painful, but a fibrous band persists. Unfortunately, aetiology and management are not very clear, but it is a self-limiting condition in most cases.

We are presenting a rare case of a patient who developed Mondor's disease in the antecubital fossa of the right arm following chemotherapy for breast cancer.

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: A Rare Cause of Chest Pain in the Emergency Department

Thrombophlebitis of a subcutaneous vein, known as Mondor's disease, is a rare cause of chest pain and can mimic several more life-threatening diseases. Mondor's disease can be caused by trauma, or hypercoagulable states; however, in many cases the etiology is unknown. Mondor's disease is usually self-limited and can be managed conservatively. In this case report, we highlight a 52-year-old male patient who presented to our emergency department with chest pain caused by Mondor's disease mimicking a pulmonary embolism. Although a rare and benign diagnosis, Mondor's disease should be part of the differential diagnosis of chest pain and can be made on the basis of a thorough history and physical examination alone. Recognition of Mondor's disease could reduce costs and risks of further testing for patients presenting with chest pain.

Association of Mondor's disease with oral contraceptive pills

Mondor's disease (MD) is a rare disease characterised by thrombophlebitis of superficial veins in the body. We describe a case of a 28-year-old woman with a painful cord-like lesion of the right breast (3 cm) overlying the right upper quadrant. The patient was recently prescribed metformin and oral contraceptive pills for symptomatic polycystic ovarian syndrome. Right breast ultrasound showed a tubular anechoic structure with several areas of narrowing, resembling a beaded appearance. The patient was diagnosed with MD associated with use of oral contraceptive pills. We recommended the patient to discontinue oral contraceptive because discontinuation of the causative drug is important. The patient was started on topical non-steroidal anti-inflammatory drugs and a therapeutic dose of enoxaparin. The patient showed significant clinical improvement after 5 days. At 6-week outpatient follow-up, complete resolution of the disease was noted.

Mondor's Disease: A Review of the Literature

Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. The diagnosis of MD is rather straightforward and based on a physical examinations. However, some case occur "secondary" with another underlying disease, including malignancy, a hypercoagulative state, and vasculitis. Therefore, it is critical to identify MD precisely, evaluate any possible underlying disease, and avoid any unnecessary invasive tests or treatment. In this paper, we comprehensively review the clinical characteristics of MD.

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.

The Effectiveness of Diclofenac Sodium in the Treatment of Mondor's Disease of the Breast: The Topical Patch Compared to the Oral Capsules

Mondor's disease of the breast is a rare, benign sclerosing superficial thrombophlebitis of the subcutaneous veins of the anterior or lateral chest wall, which is treated conservatively. We aim in this study to evaluate the outcome and effectiveness of our treatment protocol using oral diclofenac sodium and topical diclofenac sodium patch in 172 patients. A retrospective database analysis of 172 female patients between January 2001 and December 2010 was done. The treatment protocol consisted of group 1: treatment by oral diclofenac sodium 100 mg once daily for 3 weeks. Group 2: treatment by diclofenac sodium patches for 8 hours twice daily (morning and evening) for 1 week. The patients were instructed to document the time as soon as pain relief is achieved following the patch application and the intake of the oral dose. The incidence rate was 2.49%. Diclofenac sodium patch was statistically found to be significantly better in subsiding the inflammatory process of the veins, relieving the pain, and enhancing faster healing rate. We conclude that diclofenac sodium patch showed a promising role in the treatment of Mondor's disease of the breast by significantly decreasing the inflammatory process due to its transdermal migration action within a short period and the ability to reach a high local concentration. It achieved the best results for rapid relief of pain and disease regression compared to the oral capsules. Therefore, our protocol was changed to implement diclofenac sodium patch as the first choice in treating Mondor's disease of the breast.

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.

Cordoniform morphea: a clinicopathologic study of two cases presenting with the rope sign

BACKGROUND

Morphea clinically presenting as cordoniform lesions has not been described previously in the literature.

OBJECTIVE

Our goal was to describe the clinicopathologic features of morphea presenting with cord-like cutaneous lesions.

METHODS

The clinical notes of 420 patients with a diagnosis of morphea seen during the previous 10 years were reviewed to identify any cases that had cordoniform lesions at presentation.

RESULTS

Two adult patients (one male and one female) were identified. Both patients presented with chronic, slightly burning, bilateral, erythematous, linear or curvilinear elevated cutaneous indurations on the lateral chest wall strikingly reminiscent interstitial granulomatous dermatitis with arthritis. Histopathologically, typical changes of deep morphea with a band-like involvement only of the lower part of the reticular dermis and the superficial hypodermis and a remarkable perineural arrangement of the lymphoplasmocytic infiltrate were observed. The presence of Borrelia in skin biopsy samples of both patients was shown by immunohistochemistry and focus floating microscopy. In one patient, the presence of Borrelia afzelii DNA in the cutaneous biopsy was shown by polymerase chain reaction.

CONCLUSIONS

Cordoniform morphea is an exceedingly unusual and previously undescribed clinicopathologic presentation of morphea where Borrelia infection may play a causal role.

Abdominal Mondor disease mimicking acute appendicitis

INTRODUCTION

Mondor disease (MD), a superficial thrombophlebitis of the thoraco-epigastric veins and their confluents is rarely reported in the literature. The superior epigastric vein is the most affected vessel but involvement of the inferior epigastric vessels or their branches have also been described. There is no universal consensus on treatment in the literature but most authors suggest symptomatic treatment with non-steroid anti-inflammatory drugs (NSAIDs).

CASE REPORT

We report the case of a marathon runner who presented with right iliac fossa pain mimicking the clinical symptomatology of an acute appendicitis. The history and the calculated Alvarado score were not in favor of an acute appendicitis. This situation motivated multiple investigations and we finally arrived at the diagnosis of MD.

DISCUSSION

Acute appendicitis (AA) is the most common cause of surgical emergencies and one of the most frequent indications for an urgent abdominal surgical procedure around the world. In some cases, right lower quadrant pain remains unclear in spite of US, CT scan, and exclusion of urological and gynecological causes, thus we need to think of some rare pathologies like MD.

CONCLUSION

MD is often mentioned in the differential diagnosis of breast pathologies but rarely in abdominal pain assessment. It should be mentioned in the differential diagnosis of the right lower quadrant pain when the clinical presentation is unclear and when acute appendicitis has been excluded. Awareness of MD can avoid misdiagnosis and decrease extra costs by sparing unnecessary imaging.

The Role of Sonographic Imaging to Assess the Pathophysiology of Cording in Patients Treated for Breast Cancer

The pathophysiology of cording (visible bands of tissue that can form in the ipsilateral axilla and arm following breast cancer surgery) remains equivocal. Cording can be a painful and functionally limiting condition. Our aim was to assess the role of duplex ultrasonographic imaging as a diagnostic tool for assessment of this condition. We evaluated five women who had undergone surgery for unilateral breast cancer. Cording was identified by self-report and confirmed by physical examination. Duplex ultrasonography was performed within one week of the clinical diagnosis of cording. Duplex ultrasonography failed to identify the cording structures and does not appear to be a useful diagnostic tool for determining the pathophysiology of cording following treatment for breast cancer. Research focusing on intervention strategies to facilitate the clinical resolution of cording following breast cancer surgery is needed.

Mondor's disease in a patient after a mammotome biopsy

Mondor's disease is a rare, benign condition characterised by thrombophlebitis affecting subcutaneous veins of the chest and/or abdomen without an accompanying inflammatory response. The disease has a multifactorial etiology and its course is benign. It is usually self-limiting or it is eliminated by local treatment. Mondor's disease in the thoracoepigastric region may be a rare complication of mammotome biopsy. The case presentation describes a 32-year-old patient with Mondor's disease in the thoracoepigastric region after an ultrasound-guided mammotome biopsy of a breast. In the histopathological examination the lesion was diagnosed as fibroadenoma. Regardless of the disease's etiology, it is recommended to carry out diagnostic examinations to exclude co-occurring breast cancer.

A systematic review of axillary web syndrome (AWS)

INTRODUCTION

Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes.

METHODS

Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken.

RESULTS

Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction.

CONCLUSIONS

AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.

Diagnosis of Mondor's Disease in the Emergency Department with Bedside Ultrasound

Mondor's disease is a rare condition characterized by a superficial thrombophlebitis that can occur in the thoracoabdominal and genital areas. Findings with ultrasound in penile Mondor's disease are readily measurable: a noncompressible penile vein without flow and absence of tears of the corpus cavernosum or tunica albuginea, hematoma, or evidence of fracture of the penis. We present a case of Mondor's disease, diagnosed with bedside ultrasound, in the emergency department. Ultrasonography is readily available within the emergency department, and we suggest its use in aiding diagnosis of genitourinary disorders such as Mondor's disease.

Benign breast disorders

Full understanding of benign breast disease should enable the obstetrician-gynecologist to appropriately evaluate symptoms, distinguish between benign and malignant processes, determine which benign breast lesions require surgical management, and identify patients who are at increased risk of developing breast cancer. This article reviews nipple discharge, breast pain, palpable breast masses, adolescent breast disorders, inflammatory lesions (including mastitis and breast abscesses), and benign breast abnormality detected on imaging and biopsy. Each topic provides a review of the clinical presentation, a discussion of the appropriate workup, and a further description of specific etiology within each category.

Cording following treatment for breast cancer

Treatment for breast cancer may result in the formation of palpable cords in the axillary region. Our aim was to evaluate cording incidence, risk factors, and association with upper extremity functional impairment and measured arm volume change. We included 308 patients with unilateral breast cancer prospectively screened for upper extremity lymphedema, symptoms and function. Patients were assessed pre- and post-operatively and at 3-8-month intervals with perometer arm measurements and the LEFT-BC questionnaire. Cording was determined by patient self-report. The cumulative incidence of cording and its association with clinicopathologic factors, upper extremity functional impairment, and measured arm volume change were analyzed. 31.5 % (97/308) of patients reported cording, with a cumulative incidence of 36.2 % at 24 months post-operative. Clinicopathologic factors significantly associated with cording by multivariate analysis included axillary lymph node dissection (p < 0.0001) and younger age at diagnosis (p = 0.0005). Cording was associated with increased functional impairment (p = 0.0018) and an arm volume increase of ≥5 % (p = 0.028). Cording following breast cancer treatment is common, and may occur beyond the post-operative period. Our findings emphasize the importance of identifying patients at high risk for cording, and developing strategies to minimize functional impairment and arm volume elevation associated with cording. Future studies should investigate the effectiveness of interventions for cording following breast cancer treatment.

A presentation of penile Mondor's disease

Mondor's disease can manifest itself in the penile dorsal vein. It is a rare complaint with a quoted incidence of 1.39%. We report a case of a 41-year-old man who has sex with men (MSM), who presented with penile swelling and painful erections following intensive and vigorous sexual activity. He was found to have a thrombosis of the penile dorsal veins. He was managed with non-steroidal anti-inflammatory drugs and sexual abstinence and his symptoms resolved in the following two weeks. Practitioners need to beware of Mondor's disease as a differential diagnosis in the presence of penile swelling and not underestimate the anxiety it can cause the patient.

Mondor disease: a case report in ED

Mondor disease is a form of superficial thrombophlebitis affecting the subcutaneous veins, specifically of the anterolateral thoracoabdominal wall. Clinical presentation is commonly a subcutaneous, tender, painful cordlike induration, usually founded in the breast or axilla. It affects typically middle-aged women. A 36-year-old patient was admitted to the emergency department to a chest discomfort and to discovery of a palpable, nonerythematous, and painful cordlike structure running from the inferior pole of her left breast to the left iliac pit. She had no history of trauma, injury, or intensive physical activity. Ultrasonography confirmed thrombosis of the thoracoepigastric vein. A thrombophilic workup performed 2 years ago was normal. The patient was treated by enoxaparin 1 mg/kg per day for 30 days. Evolution was favorable. The etiology of Mondor disease remains unclear. Predisposing factors are mainly trauma, excessive physical activity, surgery, infections. Ultrasonography is used to confirm the diagnosis. Coagulation tests should be performed to exclude hypercoagulability condition. In the past, symptomatic approach with anti-inflammatory drugs was proposed. Recent guidelines suggest prophylactic or intermediate doses of low-molecular-weight heparin for at least 4 weeks. Although uncommon, Mondor disease has to be recognized to avoid useless diagnosis testing and to deliver a specific treatment.

Mondor's Disease in the Arm after Intravenous Chemotherapy Following Breast Cancer Surgery

We present a case of superficial thrombophlebitis of the arm, known as a variant of Mondor's disease. A 71-year-old woman who underwent a left simple mastectomy with axillary dissection for breast cancer had a cord-like vein structure in the right antecubital fossa following postoperative intravenous chemotherapy, and complained of limited elbow extension due to the firm and inflexible structure. She successfully underwent surgical resection of the vein cord to relieve the elbow motion limitation.