Thrombophlebitis Resembling Mondor’s Disease: A Case Report

Abstract

INTRODUCTION: Mondor’s disease (MD) is a rare benign breast condition characterized by thrombophlebitis of the superficial veins in the subcutaneous fat of the breast or anterior chest wall. The etiopathogenesis of MD remains controversial and, in the absence of a proven pathophysiological mechanism, a multifactorial phenomenon has been postulated. Various authors have associated the disease with local trauma, including biopsy or surgery, cancer, muscular strain, tight clothing, radiation and large pendulous breasts. Inflammatory and infectious agents have also been proposed as etiologic factors. The thoracoepigastric, superior epigastric and lateral thoracic veins are the most commonly involved, especially the last of these. Although the internal mammary vein receives drainage from the medial aspect of the breast, it is rarely affected. Bilateral involvement is unusual too. We report a case of bilateral thrombophlebitis resembling Mondor’s disease involving the lateral thoracic veins and the internal mammary veins, with multiple simultaneous or separate recurrences in both breasts. CASE REPORT: A 44-year-old Brazilian woman presented at the outpatient clinic of the Fortaleza General Hospital (HGF). On physical examination, the patient presented very large pendular breasts and a 35 cm long subcutaneous, ulcerated cord-like induration in the inner quadrants of the right breast. Several old scars were observed bilaterally in the topography of the thoracic lateral veins and internal veins. Dilated superficial veins were observed in both breasts. The patient was submitted to mammography and sonography, but no lesions were detected. DISCUSSION: The classical form of MD is lateral, unilateral and self-limited thrombophlebitis of the mammary veins. In contrast, in our patient MD affected the lateral thoracic veins and the internal mammary veins bilaterally, with multiple recurrences. Despite all efforts, the main cause was not identified, as with many other cases reported in the literature. In fact, other case reports have associated large and pendular breasts with MD. The major clinical significance of MD is that the condition can mask malignant lesions. No specific treatment is needed in most cases and and follow-up is strongly recommended.