Background

Mondor’s disease, also known as Mondor’s syndrome, is a rare medical condition characterized by the inflammation of the blood vessels (phlebitis) and the formation of blood clots (thrombosis) in superficial veins.  

These veins are typically located just beneath the skin’s surface, and the condition often affects the chest wall, although it can occur in other locations as well. Mondor’s disease is typically benign and self-limiting, meaning it tends to resolve on its own without causing severe complications. 

Epidemiology

Mondor’s disease is considered uncommon, and its incidence is relatively low. It tends to affect individuals of all ages, but it is more frequently reported in adults, particularly in women. 

There appears to be a slight predilection for Mondor’s disease to occur in women, especially in cases involving the chest wall. It is relatively rare in men, but cases have been reported. 

Mondor’s disease can be idiopathic, meaning it occurs without an apparent cause, but it can also be associated with trauma, surgery, or certain medical conditions.  

Anatomy

Pathophysiology

The initial event in Mondor’s disease is often the inflammation and injury of the affected blood vessels. This can be triggered by various factors, including trauma to the area, surgical procedures, or underlying medical conditions. The inflammation may cause damage to the inner lining of the vein. 

In response to inflammation and vascular injury, the body’s natural response is to initiate blood clot formation. The clot, or thrombus, can develop within the affected vein. This thrombosis can partially or completely block the blood flow within the vein, leading to further inflammation and pain. 

Inflammation and thrombosis can cause the vein to become swollen and firm, creating a cord-like or nodular structure under the skin. This is often associated with localized pain, tenderness, and discomfort in the affected area.  

Etiology

Physical trauma or injury to the affected area is a known trigger for Mondor’s disease. This trauma can include direct blows, bruising, or pressure on the vein. Trauma-induced phlebitis can lead to the formation of blood clots within the vein. 

Surgical procedures, particularly those involving the chest or breast area, can lead to Mondor’s disease. This can occur after breast augmentation, breast reduction, or other surgeries in which the veins are manipulated or injured during the procedure. 

Certain inflammatory conditions or diseases may increase the risk of developing Mondor’s disease. These conditions can include autoimmune disorders or connective tissue diseases. 

Genetics

Prognostic Factors

The presence of an underlying condition or cause, such as an infection or malignancy, may influence the prognosis. Treating the primary cause effectively can lead to a better outcome. 

Early diagnosis and intervention can help manage symptoms and potentially reduce the duration of the condition. Prompt medical attention is important to prevent complications and alleviate discomfort. 

The anatomical location of Mondor’s disease can affect the prognosis. Some locations may be more challenging to manage than others, and the potential for complications may vary. 

The intensity and duration of symptoms, such as pain and tenderness, can impact the prognosis. Severe and persistent symptoms may require more aggressive management. 

Clinical History

In adults, Mondor’s disease is more commonly reported, particularly in women. It can occur at any adult age, and cases have been documented in individuals ranging from their 20s to their 70s. 

Physical Examination

In many cases, Mondor’s disease presents as a visible, cord-like or nodular structure just beneath the skin. The examiner will look for any redness, swelling, or discoloration in the affected vein or surrounding tissues. 

Palpation is a key component of the physical examination. The healthcare provider will gently press and feel the affected area to assess for tenderness, warmth, and the presence of a palpable cord-like structure. 

The patient will be asked about the nature, location, and intensity of pain or discomfort they are experiencing. This information can help gauge the severity of symptoms and track changes over time. 

Depending on the location of Mondor’s disease, the examiner may assess adjacent areas to rule out other conditions or assess the extent of involvement.  

Age group

Associated comorbidity

Mondor’s disease can be associated with underlying infections, particularly in cases where it occurs in the breast area. Mastitis, an infection of the breast tissue, can sometimes lead to the development of Mondor’s disease. Managing the underlying infection is important for a complete recovery. 

Trauma or injury to the affected area can be a risk factor for the development of Mondor’s disease. Comorbidities related to the trauma may include contusions, hematomas, or other soft tissue injuries. 

Hormonal changes, such as those associated with menstruation or hormonal therapy, may be associated with the development of Mondor’s disease in some cases. Managing any hormonal imbalances or underlying conditions may be necessary. 

Associated activity

Acuity of presentation

Mondor’s disease can have a relatively sudden and acute onset. This means that the symptoms, such as pain, tenderness, and the appearance of a cord-like or nodular structure under the skin, may develop rapidly. This acute presentation is often associated with traumatic injuries, surgical procedures, or infections. 

Mondor’s disease can also have a subacute onset, meaning the symptoms may develop more gradually over a period. The pain and discomfort may be mild initially and become more pronounced as the condition progresses.  

While Mondor’s disease is generally a self-limiting condition that resolves on its own over a few weeks to a few months, some cases may have a more chronic or persistent course. These cases may have milder symptoms that persist for a longer duration before gradually improving. 

The acuity of presentation may also depend on the specific location of Mondor’s disease. For example, chest wall Mondor’s disease is a common presentation and may be more acutely painful, while cases in other locations, like the abdomen or the limbs, may vary in acuity. 

Differential Diagnoses

• Deep Vein Thrombosis (DVT): DVT is a more serious condition that involves blood clot formation in deep veins, typically in the legs. While Mondor’s disease affects superficial veins, DVT affects deeper vessels.  
• Lymphangitis: Lymphangitis is inflammation of the lymphatic vessels, which can present with red streaks along the skin and similar pain and swelling.  
• Cellulitis: Cellulitis is a bacterial skin infection that can cause localized redness, warmth, and swelling. It may need to be ruled out if Mondor’s disease is accompanied by signs of infection or cellulitis-like symptoms. 
• Superficial Thrombophlebitis: Superficial thrombophlebitis is a condition characterized by inflammation and blood clot formation in superficial veins. The key difference is that Mondor’s disease often presents as a cord-like structure beneath the skin, while superficial thrombophlebitis may have more localized redness, warmth, and swelling along the vein. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Observation: In many cases, healthcare providers may opt for an initial approach of observation and reassurance. Patients are advised that Mondor’s disease is usually a benign condition and that it tends to improve with time.  
• Pain Management: Pain relief is an essential component of treatment for Mondor’s disease. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, may be recommended to alleviate pain and discomfort.  

• Avoidance of Aggravating Factors: Patients are typically advised to avoid factors that may exacerbate the condition, such as trauma or excessive pressure on the affected area.  
• Treatment of Underlying Causes: If Mondor’s disease is associated with an underlying condition, such as an infection or malignancy, the primary cause should be addressed and treated accordingly.  
• Follow-Up: Regular follow-up appointments may be recommended to monitor the resolution of Mondor’s disease, assess any changes in symptoms, and ensure that there are no complications or recurrences. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-treating-mondor-disease

• Wera Loose Cloths: Wear loose-fitting clothing, especially around the affected area. Avoid tight undergarments or clothing that may put pressure on the vein or exacerbate discomfort. 
• Comfortable Bras: In cases of Mondor’s disease affecting the chest wall, it’s essential to wear comfortable bras without underwires that may press on the affected area.  
• Pillow Support: When sleeping or resting, use pillows to support and elevate the affected area if it is on the limbs or chest. This can help reduce pressure on the veins and alleviate discomfort. 
• Pain Management: Take pain-relieving medications, such as over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). 
• Avoid Trauma: Be cautious and avoid activities that might cause trauma or injury to the affected area. This can include lifting heavy objects or participating in activities that may lead to accidental bumps or injuries. 
• Regular Movement: Gentle and regular movement of the affected limb can help prevent stiffness and promote circulation. Simple exercises, like ankle or wrist rotations, can be beneficial. 
• Stay Hydrated: Stay well-hydrated, as dehydration can exacerbate the symptoms of phlebitis or thrombosis. Drinking plenty of water can help maintain healthy blood flow. 

Use of NSAID’s

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and reduce inflammation in various medical conditions, including Mondor’s disease. 

Indomethacin: As an NSAID, it is effective at relieving pain, which is one of the primary symptoms of Mondor’s disease. The pain in this condition is often due to inflammation and the presence of a blood clot within the affected vein. Indomethacin can help reduce pain and make the patient more comfortable. 

Indomethacin works by inhibiting the action of enzymes responsible to produce prostaglandins, which are inflammatory molecules. By reducing inflammation, indomethacin can help decrease swelling, tenderness, and redness in the affected area. 

Role of LMW Heparins

Low molecular weight heparins (LMWHs) are anticoagulant medications commonly used to prevent and treat blood clots. 

The use of LMWHs for Mondor’s disease may be considered in specific cases with unusual or severe presentations. Treatment with LMW heparin has been reported in some cases.  

This is not recommended without an underlying hypercoagulable state inciting superficial thrombophlebitis and associated Mondor cord.  

Administration of Intralesional <a class="wpil_keyword_link" href="https://medtigo.com/drug/triamcinolone-intranasal/" title="triamcinolone" data-wpil-keyword-link="linked">triamcinolone</a> injections

The primary goal in managing Mondor’s disease is to alleviate symptoms, such as pain and inflammation, and promote the body’s natural healing process.  

Intralesional triamcinolone injections for Mondor cord after breast augmentation have been successfully used for shortening of this disease.  

use-of-intervention-with-a-procedure-in-treating-mondor-disease

• Warm Compresses: Applying warm compresses to the affected area can help reduce pain and inflammation, as well as promote the resolution of the blood clot within the affected vein. 
• Avoidance of Aggravating Factors: Patients are advised to avoid actions or clothing that may exacerbate the condition, such as tight clothing or underwire bras. 

use-of-phases-in-managing-mondor-disease

• Diagnosis and Evaluation: The initial phase involves seeking medical evaluation when symptoms consistent with Mondor’s disease are noticed.  
• Acute Management: The next phase focuses on managing the acute symptoms of Mondor’s disease, including pain, tenderness, and discomfort. 
• Pain management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers may be recommended to alleviate pain. 
• Avoiding aggravating factors: Patients are advised to avoid tight clothing and activities that may exacerbate symptoms. 
• Long-Term Care and Prevention Phase: After the acute phase, patients can transition to long-term care and prevention strategies. 

Medication

Future Trends

Media Gallary

References

Mondor Disease – StatPearls – NCBI Bookshelf (nih.gov) 

Mondor disease (breast) | Radiology Reference Article | Radiopaedia.org