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Internal Medicine

Mondor’s disease (MD)

Self-limited, benign thrombophlebitis presenting as palpable subcutaneous cord-like indurations beneath the skin.

Self-limited, benign thrombophlebitis presenting as palpable subcutaneous cord-like indurations beneath the skin.

History:

Cases with cord-like lesions on the chest wall were first reported in the early 1850s, and Henri Mondor, a French surgeon, reported a case series and described them in detail in 1939. Subsequently, similar cord-like indurations occurring at the abdominal wall, groin, axilla, and penis were also reported. Although no formal classification has yet been established, MD on the anterolateral thoracoabdominal wall is generally recognized as original MD, while similar abnormalities on other sites, such as the penis and axilla, are recognized as variants of MD. In 1955, Braun-Falco defined dorsal phlebitis of the penis in the context of generalized phlebitis. Isolated thrombosis of the dorsal superficial vein of the penis was first reported and Penile Mondor’s disease was defined by Helm and Hodge in 1958 The former is called penile MD (PMD) – first reported by Helm and Hodge in 1958 – and the latter is called axillary web syndrome (AWS)-first reported as a complication of axillary surgery by Moskovitz et al. in 2001. Almost all cases of MD are reported to be thrombophlebitis of the superficial vein, although some are reported to be lymphangitis and/or a combination of both the etiologies.

There are less than 400 reported cases of Mondor Disease in medical literature


Classification

Original MD:

Thoracoepigastric, superficial epigastric, and lateral thoracic veins are the most common sites of involvement.
  • Anterolateral thoracoabdominal wall

Variant MD:

  • Penile MD (PMD): Dorsum & dorsolateral aspects of the penis
  • Axillary web syndrome (AWS): Mid-upper arm after axillary surgery.

Local trauma:

Result in sclerosing superficial thrombophlebitis and the resulting palpable cord
  • Anterior chest lesions:
    • Repetition injury: Tight brassier, or strenuous exercise, weight lifting
    • Surgical trauma: Cosmetic mammoplasty, mastectomy, breast-conserving surgery, after core needle biopsy
  • Penile lesions: Excessive sexual activity, trauma, or abstinence
  • Axillary injuries: Axillary lymph node dissection, sentinel lymph node biopsy for breast cancer

Clinical features

  • Sudden onset of mild discomfort with a palpable cord in the affected area.
  • Physical findings: Palpable cord with scant overlying inflammation and no distal edema

Diagnosis

The diagnosis of Mondor Disease is a clinical one confirmed by history and physical alone.

Ultrasound:

  • Non-compressible, hypoechoic tubular structure which is the superficial vein.
Ultrasound scan showing dilated superficial vein (Left thorocoepigastric vein) with anechoic lumen (red arrow) | Ultrasound scan showing dilated superficial vein (Left thorocoepigastric vein) with anechoic lumen (red arrow)

Management

Resolves in four to eight weeks without any specific treatment.

  • Warm compresses
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Abstinence from irritating clothing or activities

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