Mondor's disease

Superficial thrombophlebitis of the chest wall is an uncommon condition. It was first reported by Flagge in 1869 but recived wider attention in 1939 through the French surgeon Henri Mondor, who reviewed several cases. It has been commonly referred to as Mondor's disease at that time. [1] We report on a woman recently diagnosed with this condition. We believe this is the first case of Mondor's disease associated with a human bite.

Case History

A 32-year-old woman presented to our family practice center with pain inferior to her right breast area of 1 week's duration. Her past medical history was significant for cholecystectomy in 1984. She denied fever or other systemic complaints. The patient reported having been involved in a fight 2 weeks previously, during which she sustained a human bite to her right breast and trauma in the chest area.

On physical examination, the patient was found to be afebrile and her vital signs to be within normal limits. She had a crescent-shaped bite mark inferior to her right nipple without associated redness, tenderness, or edema. Palpation of the anterolateral chest area revealed a thickening that was tender. Stretching the skin distally over the abdominal wall revealed a subcutaneous cordlike lesion that measured approximately 10 cm in length (Figure 1). No overlying hyperemia, warmth, or edema was noted. Examination of the ipsilateral breast revealed no masses and there was no lymphadenopathy in the axilla. No abrasions or contusions were noted.

Results of laboratory tests obtained at that visit were a white blood count of 5.9 x [10.sup.9.L] (5,900/dL), hematocrit of 36.9%, hemoglobin of 117 g/L (11.7 g/dL), platelet count of 384 x [10.sup.9.L] (384,000/dL), and a Wintrobe erythrocyte sedimentation rate of 25 mm/h.

At follow-up examination 2 weeks later, the bite mark had healed and the subcutaneous cordlike lesion was nontender and measured 4 cm in length.

Discussion

Mondor's disease refers usually to thrombophlebitis of the thoracoepigastric vein of the anterolateral chest wall. It has been described more frequently in women, although it can occur in men (3:1 ratio). The diagnosis is often made in breast clinics. In one report, 6 out of 750 women presenting for evaluation of a breast complaint in 1 year were found to have Mondor's disease. [2]

The exact cause is unclear, but Mondor's disease is often associated with recent local trauma, muscular strain, or breast surgery. It is not associated with underlying cancer. In a recent case report, it was thought to be secondary to intravenous drug abuse. [3]

The primary pathological findings are minimal inflammatory changes, thrombosis, and organization of the involved superficial vein.

The presenting complaint is usually progressive pain in the lateral chest wall. On physical examination, a superficial, tender fibrous cord fixed to the skin can be palpated. It is usually located anywhere from the lateral aspect of the breasts to the epigastrium. A furrow or shallow groove over the cord is highlighted by the addition of slight caudal traction below the lesion. The cord stands out like a bowstring when the skin around it is stretched. [4]

Johnson et al [5] reviewed biopsy specimens from seven patients thought to have Mondpr's disease. Veins from affected areas were histologically examined. In all cases, minimal inflammation was present. The changes were classified into four stages. First, there is attachment of a thrombus to the venous wall. Second, a mucinous matrix forms with organization of the thrombus. Third, recanalization and formation of a small lumen occurs. The last stage involves recanalization and thickening of the fibrous wall.

The condition is benign and self-limited. No treatment is needed, and antibiotics have not been shown to alter the course. Pain or tenderness usually persists from 1 to 6 weeks, and the cord may last from 1 to 7 months. [5] Analgesics help with symptomatic relief. There appears to be no risk of embolization.

It is important to make the diagnosis of Mondor's disease in order not to confuse the condition with systemic diseases or lymphatic spread from carcinoma, thus avoiding unnecessary biopsy. The incidence of Mondor's disease in the family practice setting is unknown.

Key words. Thrombophlebitis; breast; bites; Mondor's disease.

References

[1] Love SM, Schnitt SJ, Conolly JL, Shirley RL. Benign Breast disorder. In: Harris JR, ed. Breast diseases. Philadelphia: JB Lippincott, 1987:46-7.

[2] Thrombophlebitis of the superficial veins of the breast (Mondor's disease). In: Haagensen CD, ed. Diseases of the breast. 3rd ed. Philadelphia: WB Saunders, 1986: 379-82.

[3] Cooper RA. Mondor's disease secondary to intravenous drug abuse. Arch Surg 1990; 125:807-8.

[4] Honig C, Rado R. Mondor's disease--superficial phlebitis of the chest wall. ann Surg 1961; 153:589-91.

[5] Johnson CW, Wallrich R, Helwig BE. Superficial thrombophlebitis of the chest wall. JAMA 1962; 180:103-8.

Submitted, revised, August 21, 1991.

From the Department of Family Medicine, University Hospitals of Cleveland, Case Western Reserve University, Ohio. Requests for reprints shoud be addressed to George E. Kikano, MD, Department of Family Medicine, University Hospitals of Cleveland, 2078 Abington Rd, Cleveland, OH 44106.

COPYRIGHT 1991 Dowden Health Media, Inc.
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