Mondor's disease of the breast: A cutaneous thromboembolic manifestation of Covid-19?

Abstract

Background: Mondor's disease is a rare disorder characterised by thrombosis of superficial veins within the subcutaneous tissue of the breast and other organs. While factors such as trauma, infection, physical exertion, breast cancer and breast surgery have been implicated, in the majority no cause is identified.

Patients: Twenty patients presented with a clinical diagnosis of Mondor's disease to the Edinburgh Breast Services in 2020. We present the etiopathogenic data as well as clinical and imaging diagnostic findings.

Results: During 2020, the annual incidence of Mondor's disease, in the UK's largest breast unit, increased five-fold compared to data from the previous year. This variation in the frequency of cases corresponded to trends in the frequency of Covid-19 infection during the pandemic. None of the patients had diagnosed COVID and few had any known etiopathogenic causes for their Mondor's.

Conclusion: Several recent studies have provided evidence for links between Covid-19 and thromboembolic events. Isolated reports have proposed a link between Covid-19 and Mondor's disease of the penis. Here we present data on a large series of Mondor's disease of the breast supporting a link between breast Mondor's and Covid-19.

Fig. 1

Monthly incidence of Mondor's disease of the breast diagnosed at Edinburgh Breast Services and monthly incidence of Covid-19 in Scotland. Graph showing mean and standard deviation for daily incidence of Covid-19 new diagnoses recorded for each month in Scotland during 2020 from the Scottish Government Population Health Directorate (left y-axis) and the total number of Mondor's disease cases diagnosed within Edinburgh Breast Services during 2020 (right y-axis, orange).

Fig. 2

Medical photograph of Mondor's disease from one of the patients who presented during 2020. A linear bifurcating indentation, representing a thrombosed vessel, can be seen coursing down the lateral aspect of the right breast, typical of Mondor's disease. Signed informed consent was obtained from the patient allowing for used and publication of the above photograph.

Fig. 3

Ultrasound Images. Focused ultrasound scan of reddened area in left lateral breast and region superior. There was skin thickening measuring 3.8 mm at the site of the red skin in the left lateral breast at 3–4 o'clock (C). No underlying collection was present. Slightly superior at 2–3 o'clock at the site of ridge-like lumpiness, there was an elongated blood vessel lying below the dermis, which was not completely compressible and does not demonstrate colour flow on doppler (A + B). Appearances are in keeping with thrombosis and a diagnosis of Mondor's disease of the breast.