Original Report

Mondor's Disease of the Breast

Sonographic and Mammographic Findings

Mahesh K. Shetty1,2 and Alfred B. Watson2

1
Department of Radiology, The Woman's Hospital of Texas, 7600 Fannin St., Houston, TX
77054.
2
Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

Received January 23, 2001; accepted after revision March 28, 2001.

Address correspondence to M. K. Shetty.

Abstract Top
Abstract
Introduction
Subjects and Methods
OBJECTIVE. The purpose of this study was to evaluate the Results
mammographic and sonographic findings in patients with Discussion
Mondor's disease of the breast. References

CONCLUSION. The combination of a sonographic finding of

a superficial vessel—with or without an intraluminal thrombus and without flow on
Doppler imaging—and a mammographic finding of a tubular density is the typical sign of
Mondor's disease of the breast. Women present with a palpable cordlike structure, which
is often painful, especially in the acute phase of thrombophlebitis. An understanding of
such an entity and knowledge of the imaging findings will help breast imagers avoid the
pitfall of mistaking this finding for a dilated duct.

Introduction

Mondor's disease of the breast is a rare benign breast condition Top

characterized by thrombophelebitis of the superficial veins of Abstract
Introduction
the chest wall. This condition is rarely reported, which, in part,
Subjects and Methods
may be due to lack of awarness of the entity. Little has been Results
written about the imaging findings in patients with Mondor's Discussion
disease. A search of the literature showed a single published References
study—a case report that described the mammographic
findings in patients with this condition [1]. An understanding
of the pathophysiology, clinical presentation, and the imaging findings is important for
the breast imager. Patients usually present with a painful breast mass, and, although
Mondor's disease is usually a benign, self-limiting condition, imaging is recommended
primarily for the evaluation of the palpable mass. An association with breast cancer has
been reported [2].

Subjects and Methods

During the 1-year period between October 1999 and Top

September 2000, five patients with Mondor's disease were Abstract
identified in a large mammography practice that included three Introduction
Subjects and Methods
breast centers. A standard two-view mammogram was obtained Results
in all patients. Additional spot compression images in the Discussion
craniocaudal and mediolateral oblique projections were References
obtained in four of these patients. Mammograms were obtained
using a Mammoplus (International Medical Systems,
Riverside, CA), a Senographe DMR (General Electric Medical Systems, Milwaukee, WI),
a Performa (Instrumentarium, Tuusula, Finland), or a Contour Mammography System
(Bennett Trex Medical, Copiague, NY).

Sonography was performed with a 7-MHz (or higher) transducer using Logic 700MR
(General Electric Medical Systems), 128 XP (Acuson, Mountain View, CA), SSD-5000
(Aloka, Mitaka-shi, Tokyo, Japan), and SSD-1700 (Aloka). Sonographic examinations
included real-time as well as spectral and color Doppler imaging of the area of concern.

The following information was documented for each of the patients: age, sex, clinical
presentation, and type of treatment and clinical follow-up, where appropriate. For each
patient, the presence of known associated risk factors—a history of breast surgery, breast
biopsy, breast inflammation or infection, or trauma—was documented.

Results
Top
During a 1-year period, we identified five women with Abstract
Mondor's disease of the breast in a large mammography Introduction
practice encompassing three breast centers. The patients ranged Subjects and Methods
in age from 33 to 45 years (mean age, 40 years). All had Results
Discussion
palpable findings; three had localized tenderness associated
References
with the palpable finding at the time of the mammographic and
sonographic evaluation. None of the five women had any
known risk factors. The cause of Mondor's disease in these patients was, hence, presumed
to be idiopathic in all the reported patients.
The mammograms revealed a superficially located tubular density corresponding to the
marker placed on a palpable mass in all patients. The density was seen in the upper outer
breast, indicating involvement of the lateral thoracic veins, in four patients (Figs. 1A and
1B). In the remaining patient, the thrombosed vein was periareolar, coursing deep to the
nipple toward the lower outer quadrant of the breast.

Fig. 1A. —33-year-old woman with acute tender mass in upper

outer left breast. Mediolateral oblique (A) and craniocaudal (B)
mammograms show superficial tubular density (arrows)
consistent with superficial thrombophlebitis. A small
radiopaque marker has been placed over area of painful mass.

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Fig. 1B. —33-year-old woman with acute tender mass in upper

outer left breast. Mediolateral oblique (A) and craniocaudal (B)
mammograms show superficial tubular density (arrows)
consistent with superficial thrombophlebitis. A small
radiopaque marker has been placed over area of painful mass.

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Sonograms showed a markedly dilated superficial vessel distended with a thrombus in

one patient (Fig. 2). In the remaining four patients, a tubular anechoic structure with
multiple areas of narrowing was seen, giving a beaded appearance to the vessel (Fig. 1C).
No flow was present in these structures on color or spectral Doppler studies (Fig. 3B).

Fig. 2. —Sonogram reveals markedly dilated tubular

structure with echogenic intraluminal thrombus
(arrows) in 44-year-old woman with acute superficial
thrombophlebitis in right breast.

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Fig. 1C. —33-year-old woman with acute tender

mass in upper outer left breast. Sonogram shows
dilated tubular beaded structure (arrows) consistent
with superficial thrombophlebitis.

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Fig. 3B. —44-year-old woman with tender mass at

areolar margin of right breast. Spectral Doppler
analysis shows absence of flow in tubular structure.

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Of the five women, two had palpable findings without pain and did not require treatment.
The three other patients were treated conservatively to relieve pain; one of these patients
is scheduled to have prophylactic bilateral mastectomy because of a strong family history
of breast cancer. This woman had an acute episode of thrombophlebitis with a severely
painful and enlarged breast and had experienced a similar episode affecting the opposite
breast in 1996. At 6-month follow-up, a complete clinical resolution of the superficial
thrombophlebitis was noted. Two of the other treated women also were found to have had
a complete resolution of symptoms at follow-up (1 and 5 months, respectively).

Discussion

Mondor's disease of the breast is a benign condition characterized by superficial

thrombophlebitis of the mammary region. Anatomically, the
affected veins include the lateral thoracic, thoracoepigastric, Top
and superior epigastric [3]. This condition was first described Abstract
Introduction
by Faage [4] in 1869 and was subsequently characterized by
Subjects and Methods
the French surgeon Henry Mondor [5] in 1939. Incidence rates Results
of 0.5% [6] and 0.8% [7] have been reported, but these studies Discussion
included symptomatic patients and, therefore, do not reflect the References
true incidence of the disease in an asymptomatic population [6,
7]. The etiology or the pathogenesis of this condition is still not
clear. Hogan [8] has postulated that direct trauma to the vein or pressure on the lateral
thoracic veins leading to stasis of blood may be the pathophysiologic cause. Some risk
factors cited for the development of the condition have been breast surgery, breast biopsy,
an inflammatory process, breast cancer, and trauma [2, 6, 7].

The reported association of breast cancer with Mondor's disease is of particular interest to
mammographers. Catania et al. [2] reported that eight of their 63 patients with Mondor's
disease had breast cancer and strongly recommended mammography in all cases, even
when the findings at the patient's physical examination were otherwise negative. They
reported that mammography alone identified two of the eight breast cancers. In the series
reported by Hou et al. [6], two of the 64 women with Mondor's disease had associated
breast cancer. The infrequency of Mondor's disease and the fact that these studies
included patients presenting for breast evaluation make its association with breast cancer
difficult to assess.

Fig. 3A. —44-year-old woman with tender mass at

areolar margin of right breast. Sonogram reveals
dilated tubular beaded structure (arrows) consistent
with superficial thrombophlebitis.

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Mondor's disease of the breast may present clinically as a palpable cord or a mass usually
associated with pain. Mammographic evaluation is, therefore, indicated in patients with
suspected Mondor's disease primarily for the evaluation of a palpable finding in the
breast. At mammography, the finding of a dilated tubular density may potentially be
mistaken for a dilated duct, a finding that may lead to biopsy. Huynh et al. [9] reported
that at mammography, an asymmetrically dilated duct not situated beneath the areola that
is associated with an interval change, suspicious microcalcifications, or both warrant
biopsy. The researchers in that study found that 24% of the patients with such findings
had breast cancer [9]. Tubular or branching structures in the subareolar region, however,
represent dilated ducts, and, if unassociated with other suspicious or clinical or
mammographic findings, are of minor importance [10]. Miller et al. [11] reported a case
in which a patient had both Mondor's disease and a metastatic lymph node; at
mammography, the thrombosed vessel was mistaken for a dilated duct.
At sonography, the thrombosed vessel appears as a superficially located, long, tubular,
anechoic structure with a beaded appearance that does not show any flow on color or
spectral Doppler studies. We found that sonography enables us to identify the entire
course of the thrombosed vessel, which may not be visible in a mammographically dense
breast. In patients with acute cases, a thrombus distending the vein may be seen, as in one
patient in our series. Bilaterality is rare; one patient in our series had bilateral superficial
thrombophlebitis occurring in each breast at different times. A thrombosed vein tends to
be longer than a duct, have a beaded appearance, and is seen most commonly in the upper
outer aspect of the breast. When in a periareolar location, a thrombosed vein does not
terminate at the areola, unlike a lactiferous duct. Dilated interstitial fluid collections do
not have a beaded or tubular appearance like thrombosed veins seen in patients with
Mondor's disease.

Mondor's disease is a benign and self-limiting condition; patients are conservatively

treated for pain with antiinflammatory and analgesic drugs. Antibiotics and
anticoagulants are not indicated. We believe that, after a mammographic and sonographic
work-up has been performed, a Breast Imaging Reporting and Data System (BI-RADS)
[10] category 3 assessment, with a recommendation for a short-interval follow-up in 6
months, is appropriate.

Our series was small; however, Mondor's disease is a rare entity. Breast imagers should
have an awareness of this condition and its imaging findings to avoid potentially
misdiagnosing the palpable thrombosed vessel as a dilated duct and to exclude an
associated breast cancer.

References Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
1. Conant EF, Wilkes AN, Mendelson EB, Feig SA.
References
Superficial thrombophlebitis of the breast (Mondor's
disease): mammography findings. AJR 1993;160:1201 -1203[Free Full Text]

2. Catania S, Zurida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A. Mondor's

disease and breast cancer. Cancer 1992;69:2267 -2270[Medline]

3. Pugh CM, DeWitty RL. Mondor's disease. J Natl Med Assoc 1996;96:359 -363

4. Faage CH. Remarks on certain cutaneous affections. Guys Hosp Rep (3rd series)
1869;15:295 -302

5. Mondor H. Tronculite sous-cutané subaigue de la paroi thoracique antero-laterale.

Mem Acad Chir (Paris) 1939;65:1271 -1278
6. Hou MF, Huang CJ, Huang YS, et al. Mondor's disease in the breast [in Chinese].
Kao Hsiung, I Hsueh Ko Hsueh Tsa Chih 1999;15:632 -639

7. Bejanga BI. Mondor's disease: analysis of 30 cases. J Royal Coll Surg (Edinb)
1992;37:322 -324

8. Hogan GF. Mondor's disease. Arch Intern Med 1964;113:881 -885

9. Huynh PT, Parellada AJ, Shaw de Paredas E, et al. Dilated duct pattern at
mammography. Radiology 1997;204:137 -141[Abstract/Free Full Text]

10. American College of Radiology. Illustrated breast imaging report and data
system (BI-RADS), 3rd ed. Reston, Va: American College of Radiology, 1998:128
-130

11. Miller DR, Cesario TC, Slater LM. Mondor's disease associated with metastatic
axillary nodes. Cancer 1985;56:903 -904[Medline]