Breast Pain Differential: Mondor's Disease of the Breast

Abstract

Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor's disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor's disease often resolves spontaneously with supportive care, as in this patient's case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.

Keywords: Fitzpatrick skin types; Mondor’s disease; breast pain; hypercoagulability; superficial thrombophlebitis; women’s health.

Figure 1.

Tender palpable cord. Visualization required additional lighting and skin traction. Induration originates at the lower portion of the right breast at the 6 o’clock position and extending approximately 15 cm inferiorly toward the abdomen.

Figure 2.

Diagnostic mammogram with tomosynthesis of the right breast. Mediolateral oblique view. Palpable area of concern is demonstrated by the triangle marker (white arrow). No mammographic abnormality present.

Figure 3.

Color Doppler ultrasound of the right breast. At the 8 o’clock position, 12 cm from the nipple is a superficial tubular structure (white arrow) with hypoechoic material and no visualized internal flow, compatible with a thrombosed superficial vein.

Figure 4.

Grayscale ultrasound of the right breast. At the 8 o’clock position, 10 to 12 cm from the nipple (prior area of concern), there is no focal lesion corresponding to previously seen abnormality.