Dermatology Online Journal

A case of idiopathic Mondor disease
Farid Stephan MD, Ismael Maatouk MD, Roy Moutran MD, Joyce Wehbe MD, Grace Obeid MD
Dermatology Online Journal 18 (1): 14

Department of Dermatology, Hôtel-Dieu de France, Beirut, Lebanon

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Abstract

We report a case of very clinically prominent Mondor disease for which no precipitating etiology could be determined.

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Case

A 30-year-old man presented to our clinic with a 2-week history of a cord-like induration on the thoracic wall. He was not taking any medication and denied any body-building exercises or drug abuse. There was no evidence of systemic disease and no history of trauma, hypercoagulable states, or malignancies.

Figure 1	Figure 2

Dermatological examination showed a 22 cm firm, non-painful, cord-like induration extending from the axillary region to the sternum (Figures 1 and 2). Twisting and stretching movements of the thorax and palpation of the lesion did not cause pain.

Laboratory tests (blood cell count, sedimentation rate, C-reactive protein, rheumatoid factor) were performed and yielded normal results. Sonograms of liver, spleen, pancreas, and kidneys, along with chest radiograms did not reveal any pathology. Ultrasonographic examination of the cord-like lesion revealed thrombophlebitis of a superficial thoracoepigastric vein. We did not perform explorative surgery or histopathological examination.

The patient was diagnosed with Mondor disease and was treated with a nonsteroidal anti-inflammatory drug. We followed up with the patient after 6 more weeks and the lesion had resolved.

Discussion

It was French surgeon Henry Mondor who in 1939 first characterized this condition that now bears his name [1]. Mondor disease (MD) is a rare entity of obliterative phlebitis affecting the thoracoepigastric, lateral thoracic, or superior epigastric vein. Whenever the inferior epigastric veins or their branches are damaged, the cord appears over the groin or penis [2].

It occurs mainly between the ages of 30 and 60 years and affects women three times as frequently as men [1, 2]. Clinically, the condition presents with an asymptomatic cord-like induration but can be painful as some authors reported [2].

The etiology of this condition is still not clear although it is usually related to a history of trauma, muscular strain, thoracic surgery, breast surgery, febrile illness, use of vasoconstrictor drugs, anatomical variation in the venous arcade, and venous compression [1, 2]. It may very rarely be accompanied by breast cancer.

Histologically, the disorder develops through four different stages: thrombus formation, thrombus organization, thrombus recanalization, and fibrosis of the vascular wall [1, 2].

The differential diagnosis includes subacute angiitis, cutaneous polyarteritis nodosa, and angiitis due to drugs. However, these disorders are usually more painful and affect arteries rather than veins [2]. Doppler USG is the most important tool for the diagnosis, choice of therapy, and follow-up. It is performed to exclude the existence of any underlying mass compressing the veins [1, 2].

The condition is benign, self-limiting, and requires no treatment except reassurance. Most cases resolve in 4 to 6 weeks. Antithrombotic and anticoagulant therapy may be recommended in the early stages of Mondor disease to decrease the time to resolution. Patients may be conservatively treated for pain with anti-inflammatory and analgesic drugs. In persistent symptomatic cases, surgical excision has been recommended (thrombectomy or superficial vein resection) [1, 2].

We reported this case because of its rarity. We believe that Mondor disease was idiopathic in this case.

References

1. Dirschka T, Winter K, Bierhoff E. Mondor's disease: a rare cause of anterior chest pain. J Am Acad Dermatol. 2003; 49(5):905-6. [PubMed]

2. Alvarez-Garrido H, Garrido-Ríos AA, Sanz-Muñoz C, Miranda-Romero A. Mondor's disease. Clin Exp Dermatol. 2009; 34(7):753-6. [PubMed]

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