What is Mondor Disease?
Henri Mondor first brought attention to Mondor Disease in 1939. This condition is typically defined by the hardening and inflammation of the surface veins in the chest area due to blood clots. Most commonly, the disease affects the superior epigastric vein, which is one of the major veins in the chest area. This often results in the formation of a touchable cord-like structure in the lower outer area of the breast, hence the term “Mondor cord”. Interestingly, this relatively rare condition has also been reported to affect the veins on the surface of the penis. The first report of a cord-like structure as a sign of superficial thrombophlebitis dates back to 1870, credited to an individual named Fage.
What Causes Mondor Disease?
Mondor disease is an uncommon condition that’s still not fully understood. A few different situations have been connected to it, including repeated injuries from things like a tight bra, intense physical activity (especially in bodybuilders), or injuries due to surgery. Other causes could be damage to veins, blood not flowing properly, or pressure on the veins from outside. There have also been instances of Mondor disease showing up after specific surgeries such as mammoplasty (cosmetic surgery on the breasts), mastectomy (removal of the breast), and breast-conserving surgery for breast cancer, as well as after a type of biopsy.
While some researchers have suggested that Mondor disease might be a sign of breast cancer, there isn’t clear evidence to prove this link. So, if Mondor disease is suspected, it would be a good idea to rule out breast cancer with suitable tests before deciding on the next steps for managing it.
Mondor disease can occur in different venous drainage systems (where the blood gets taken back to the heart), but it never affects the inside, upper part of the breast. The symptoms of Mondor disease can appear in various body parts like the groin, stomach, arm, or the armpit. A condition called axillary web syndrome, which often occurs after the removal of lymph nodes in the armpit for breast cancer treatment, is similar to Mondor disease.
There’s also a type of Mondor disease that affects the penis, which results in cords that are almost painless on the top side of the penis. The exact causes or mechanisms of this type of Mondor disease isn’t fully understood yet.
Risk Factors and Frequency for Mondor Disease
Mondor disease is quite rare, with less than 400 reported cases in medical documents. This might be because this disease usually resolves itself. However, if someone has this disease, they should be watched carefully due to its possible links with underlying cancer, a state where blood clots too quickly, or a condition where there is inflammation of the blood vessels. Women are three times more likely than men to develop Mondor disease. The disease doesn’t have a specific racial or ethnic group that it impacts more than others. Even though anyone can get it, the majority of cases are between the ages of 30 and 60.
- Mondor disease is rare, with less than 400 reported cases in medical studies.
- The disease usually resolves itself.
- It may have links to underlying conditions like cancer, blood clotting disorders, or blood vessel inflammation, hence careful monitoring is necessary.
- Women are three times as likely as men to have this disease.
- It affects all racial and ethnic groups equally.
- While it can happen at any age, it’s most common in people aged 30 to 60.
- A recent study found that 45% of cases occur without a clear cause, 20% are caused by medical intervention, 22% by a traumatic event, and 5% relate to breast cancer.
Signs and Symptoms of Mondor Disease
Getting a detailed patient history and conducting a physical exam is crucial for a correct diagnosis. How patients describe their symptoms may vary depending on the area of the body affected by the disease – the armpit (axillary), penis (penile), or front of the chest (anterior chest wall). However, all of these cases are often linked to three common factors (also known as Virchow’s triad): blood stagnation, an increased tendency for the blood to clot, and damage to the blood vessel wall.
Patients usually report a sudden start to their mild discomfort, along with a noticeable lump or “cord” in the area in question. In cases of penile Mondor’s disease, the patient’s history might include either too much sex, injuries, or lack of sexual activity. In the case of anterior chest Mondor’s disease, the patient might have recently gone through a chest reshaping surgery, worn a tight bra, or incurred a chest injury like lifting heavy weights or a biopsy. For armpit Mondor’s disease, the patient might have recently had cancer surgery involving the lymph nodes or a biopsy.
Typical physical signs of Mondor’s disease include an easily felt cord with little to no redness or swelling on and around it, and no swelling further down the limb. With these signs present, Mondor’s disease should be seriously considered as a diagnosis.
Testing for Mondor Disease
The diagnosis of Mondor disease is typically made based on a patient’s medical history and physical examination. Because this disease is relatively rare, there are still debates about how it should be evaluated or treated. While some scientists believe there may be a link between Mondor disease and underlying breast cancer, others think that the disease might be associated with physical trauma related to the diagnosis and treatment of the cancer.
If a patient has typical signs of Mondor disease and no other unusual symptoms, there’s usually no need for additional tests like lab work, imaging, or invasive procedures. However, if there are signs or symptoms that might suggest a different underlying condition, imaging tests like a mammogram or an ultrasound of the breast or penis might be necessary.
Ultrasound is often the first choice when additional testing is needed for Mondor disease. This test can show a firm, low-echo tube-like structure, which is the superficial vein. A blood clot may or may not be visible inside this vein. Using color Doppler ultrasound can help confirm the diagnosis by showing that there’s no blood flow within the vein. In some cases, a mammogram might show a linear density in the breast, which could indicate superficial vein inflammation. However, MRI and other advanced imaging techniques usually aren’t needed in the evaluation of Mondor disease.
Treatment Options for Mondor Disease
Mondor disease is a condition that can most often be managed with supportive care and simple at-home treatments. Warm compresses, anti-inflammatory medications, and avoiding activities or clothing that cause irritation can be the first line of treatment. Normally, these strategies lead to the resolution of the symptoms and with time, the palpable cord in your chest associated with Mondor disease will disappear.
There have been instances where aspirin or treatments with low molecular weight heparin have been used for Mondor disease. However, these types of treatment are not usually suggested unless the patient has an underlying condition that makes blood clots more likely, which can cause superficial vein inflammation and Mondor cord.
In some specific cases, like after breast augmentation surgery, injections of a medication called triamcinolone into the affected area have proven successful in speeding up the healing of this condition.
What else can Mondor Disease be?
When it comes to diagnosing Mondor disease, the exact symptoms can significantly impact the range of potential causes a doctor might consider. Some conditions that might be similar to Mondor disease, depending on the symptoms, can include:
- Thrombophlebitis migrans (migrating blood clot inflammation)
- Infectious mastitis (breast infection)
- Buerger disease (a condition affecting small and medium-sized blood vessels)
- Behçet disease (a rare disorder that leads to inflammation in blood vessels)
- Polyarteritis nodosa (a disease causing inflammation in small and medium-sized blood vessels)
Other conditions related to the breast, such as mastitis and breast abscesses, could also be considered, especially if the patient presents significant pain with possible lumps or swelling in the case of an abscess. When a patient complains of a breast-related problem, inflammatory breast cancer must always be on the doctor’s list of possibilities. This type of cancer is recognized for its rapid progression and can mimic the look of worsening mastitis with symptoms such as redness, enlargement of the breast, and pain.
What to expect with Mondor Disease
Mondor disease typically gets better on its own within six to eight weeks. However, in some situations where the disease occurs because of an overly active blood clotting condition, the outcome strongly depends on this underlying condition.
Possible Complications When Diagnosed with Mondor Disease
Mondor disease is a condition that usually improves on its own within four to eight weeks. Similar to other blood clotting conditions, there is a slight possibility that it could lead to the formation of a deep vein clot.
Common Facts:
- Mondor disease typically resolves within four to eight weeks
- There is a slight risk of developing a deep vein blood clot, similar to other clotting disorders
Preventing Mondor Disease
Doctors should explain to patients that Mondor disease is a condition that will eventually get better on its own and does not cause any lasting health issues. It’s important for patients to remember they need to attend follow-up appointments to make sure their symptoms are improving and the disease is resolving.
