Department of Radiology , Umraniye Training and Research Hospital, Istanbul, Turkey
*Ayla Turkar, Department of Radiology , Umraniye Training and Research Hospital, Istanbul, Turkey
Introduction
Mondor’s Disease is a rare, benign condition characterized by superficial thrombophlebitis of the veins of the breast. It most commonly affects women between the ages of 30-60 and is often idiopathic. However, trauma, systemic conditions such as hypercoagulabiliy, and the possibility of underlying breast cancer should be carefully evaluated in affected patients (1). The most commonly involved vein is the superior epigastric vein, which presents with findings in the lower outer quadrant of the breast (2). Patients typically present during the acute phase with a painful, palpable, cord-like subcutaneous mass. This may be accompanied by overlying skin erythema. As a self-limiting entity, treatment is usually conservative and aimed at symptom relief. Analgesic and nonsteroidal antiinflammatory drugs (NSAIDs) may be used to alleviate pain. Even without treatment, symptoms typically resolve within approximately four to eight weeks as spontaneous recanalization occurs (3).
Case Report
A 41-year-old female patient of foreign nationality, who had no health insurance and faced a language barrier, presented with a one-month history of pain, swelling, and erythema in the left breast. Despite these symptoms, she had not sought medical attention or received any treatment during the symptomatic period.
On inspection, no significant clinical findings were observed in the breast. However, sonographic evaluation revealed tortuos, tubular lesions extending from the lower inner quadrant of the left breast to the retroareolar region, localized just beneath the skin and containing hypoechoic areas. Color Doppler ultrasound showed minimal flow within the tubular structures, with no significant vascular signal. No vascularization was detected in the hypoechoic areas within the lumen of these tubular structures.
Figure 1: On grayscale ultrasound, dilated venous structures and hypoechoic reflections of thrombus (arrows) are seen within the lumen (a), and on color Doppler ultrasound, minimal flow is observed within the lumen (b)
There were no pathological findings or inflammation in the surrounding adipose tissue lobules or parenchyma (Figure).
The patient was evaluated for potential causes such as trauma, hypercoagulable states, dehydration, and central venous catheterization, but no meaningful etiological factor was identified.
Based on the current imaging findings, we diagnosed idiopathic Mondor disease, which is self-limiting and in which recanalization secondary to thrombolysis begins to develop.
Since the patient did not apply to hospital in the acute phase and was asymptomatic at the time we saw them, initial differential diagnoses included ductal ectasia and intraductal papilloma. However, color Doppler imaging allowed for clear differentiation.
Due to the lack of health insurance and the certainty of the diagnosis, no mammography or additional imaging was requested. As the patient was asymptomatic, no medical treatment was administered. At one-month follow-up, complete resolution of the thrombus was observed, and follow-up was concluded.
