European Journal of Cardiovascular Medicine

Mondor's disease of the breast is a benign and spontaneously regressive vascular mammary disorder characterized by thrombophlebitis (superficial venous thrombosis) on a healthy vein involving the superficial part of the veins of the mammary region.

We report the case of a 73-year-old patient with no surgical medical history, who had been consulted for mastodynia and had an onset of induration in the right upper quadrants for 20 days. On interrogation, the symptomatology is painful. Clinical examination reveals a palpable, thick painful cord. Oblong, extensive measuring 7 cm of internal location, without inflammatory phenomena or associated axillary lymphadenopathy. In conventional mammography imaging, the breast density was type b of ACR, with no mass or architectural distortion, no focus of microcalcifications. Breast ultrasound revealed a tubular, elongated, anechoic structure with a thin and regular wall, with finely echogenic incompressible content, without flow in the color Doppler study, surrounded by a finely echogenic aspect of the surrounding fat in relation to a thrombosed superficial vein, suggestive of Mandor thrombophlebitis (Figure 1).

Figure 1: Elongated tubular structure anechoic with thin and regular wall with finely echogenic incompressible content, without flow on color Doppler study surrounded by a finely echogenic aspect of the surrounding fat in relation to a superficial thrombosed vein.

In retrospect, the mammographic re-reading correlated with the ultrasound showed a fine linear density on the path of the anomaly detected on the ultrasound. The radiologist's record is classified as ACR BI-RADS 2 and the diagnosis is Mondor disease (Figure 2).

Figure 2: Fine linear density along the path of the anomaly detected by ultrasound.Mondor's Disease is managed conservatively in our patient with initiation of pain treatment with anti-inflammatory and analgesic, biopsy, anticoagulants and antibiotics are unnecessary. The course was favourable in the 12 weeks following the start of treatment.

The incidence of superficial thrombophlebitis of the chest wall vein is very low, in the range of 0.07% to 0.96% [1]. Mondor's disease is a superficial thrombophlebitis of the thoraco-thoracic vein A benign, rare and self-resolving, pathology that involves the thoraco-abdominal veins [2] (thoraco-epigastric, thoraco-epigastric, thoracic lateral) of which in our case it is the superior epigastric vein.

This disease mainly affects women of childbearing age [3], with extremes ranging from adolescence to the seventh decade [4], in our case it is a patient of the 7th decade. Mondor's disease of the breast is a linear, hard, tender, and motile swelling, most often located in the upper outer quadrant of the breast. This clinic is variable, most often it involves palpation of a superficial cord leading to skin retraction, pain or even skin discoloration (purplish). In addition, there are general symptoms, such as fever, mastodynia, malaise, discomfort with palpation or arm movements, which seem to be more related to the causative disease than to the breast phlebitis itself. In our case, it was mastodynia associated with cutaneous induration[5].

Etiopathogenically, the etiology of Mondor's disease of the breast is unknown in half of the cases so idiopathic, it is as in our case. Contributing factors include trauma following breast biopsy, breast surgery; Hypercoagulability (pregnancy, blood dyscrasia and oral contraceptives) [6].

The diagnosis of Mondor's disease is based on clinical examination, but imaging can be useful to confirm the diagnosis, rule out differential diagnoses and look for a possible underlying cause, in this context a work-up should be carried out including [7].

A mammogram, which is virtually silent, with no appreciable abnormalities []; Skin folding or thickening is sometimes highlighted. Mammography is an essential examination to look for associated breast neoplasia since Mondor's disease can be associated with breast cancer in about 4%. Breast ultrasound coupled with Doppler, is the basic and reference examination in venous thromboembolic pathology, which finds, in the context of Mondor's disease, the usual signs of any thrombosis, such as non-compressibility of the vein under the probe and hypoechoic endoluminal image.

The ultrasound aspect is that of a tubular, elongated, anechoic or hypoechoic non-compressible structure, without flow in the color Doppler study. which follows the path of a superficial vein of the breast. The sign of the "double rail" corresponds to the visualization of the two edges of the vein wall. Color Doppler ultrasound can confirm the absence of blood flow in the thrombosed vein as in our case [8]. In retrospect, mammography revealed a visible skin fold on the frontal incidence as well as a discrete linear density along the path of the abnormality detected on ultrasound.

CT scan may show a thickened superficial breast vein, with peripheral enhancement after injection of contrast medium. MRI may show a superficial vein of the breast in hyposignal in T1 and hypersignal in T2, with peripheral enhancement after gadolinium injection. Scintigraphy may show hyperfixation of the tracer at the level of the thrombosed vein [9]. The most likely positive diagnosis is that of superficial venous thrombophlebitis (the arguments in favor are: the formation is elongated tubular non-compressible, typical localization, painful symptomatology, absence of flow on Doppler, linear density on mammography but we do not find the classic rosary appearance on ultrasound).

The differential diagnosis is Axillary web syndrome, which is a fibrotic band with the presence of a superficial multiple thin palpable cord in the armpit extending to the upper limb and which mainly affects patients who have had armpit surgery (dissection or biopsy of the sentinel lymph node). With Morpheus (localized scleroderma) which manifests itself by skin retraction without a palpable mass. It is a localized scleroderma that affects only the dermis and spares the glandular parenchyma, Very rare idiopathic or post-radiation the clinical course is biphasic: inflammatory phase and fibrotic phase. On a également la dilatation canalaire qui correspond à une structure de forme tubulaire allongée, anéchogène, de siège rétro-aréolaire plus souvent Indolore, non palpable.

Mondor's disease of the breast is a rare, but not exceptional, condition that should be known to radiologists and clinicians. Diagnosis is primarily clinical, but imaging can be helpful in confirming, clarifying, and looking for an underlying cause. Ultrasound is the test of choice, but other techniques can be used in addition. Treatment is mostly symptomatic, and the prognosis is favorable, with spontaneous resolution within a few weeks or months[10].

1. Fatnassi R, Kaabia O, Meski S, Ben Regaya L, Mkinini I, Briki R, Hidar S, Bibi M, Khairi H. La maladie de Mondor du sein. Imagerie de la Femme. 2009;19(4):258-261.
2. Chiedozi LC, Aghahowa JA. Mondor’s disease associated with breast cancer; surgery 1988;103:438—9.
3. Quéhé P, Saliou AH, Guias B, Bressollette L. Maladie de Mondor, à propos de trois cas. J Mal Vascul 2009;34:54—60.
4. Kocaoglu M, Somuncu I, Ors F, Bulakbasi N, Tayfun C, Ucoz T. Imaging findings in breast involvement of Mondor's disease. European Journal of Radiology. 2004;52(3):296-301. [^2^][2]
5. Pugh CM, Dewitty RL. Mondor’s disease. J Natl Med Assoc 1996;88:359—63. [9] Hogan GF. Mondor’s disease. Arch Intern Med 1964;113: 881—5.
6. Tournant B. Maladie de Mondor. In: Mastodynie. Le sein. Paris: Éditions ESKA; 2007 [p. 78—9]
7. Gokalp G, Mutlu H, Sonmez FC, Yildirim D, Kosar P, Kosar U. Mondor's disease of the breast: clinical, mammographic, and sonographic findings. European Journal of Radiology. 2008;66(3):474-479.
8. Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A. Mondor’s disease and breast cancer. Cancer 1992;69:2267—70.
9. Hermann JB. Thrombophlebitis of breast and contiguous thoracoabdominal wall (Mondor’s disease). NY State J Med 1966;15:3146—52.
10. Gokalp G, Mutlu H, Sonmez FC, Yildirim D, Kosar P, Kosar U. Mondor's disease of the breast: clinical, mammographic, and sonographic findings. European Journal of Radiology. 2008;66(3):474-479.