Working Diagnosis:
Mondor's Disease

Treatment:
The patient was advised that treatment was symptomatic and that his pain could be treated with NSAIDs and warm compresses. He was advised to decrease his work-out regimen over the following 2-4 weeks to allow time for recovery.

Outcome:
The patient had resolution of his pain over the following two weeks. His indurated thrombophlebitis progressively improved over the following six weeks to the point where it was no longer palpable. The patient was able to continue to participate in coaching activities throughout his recovery. He has returned to his normal work-out routine without complications.

Author's Comments:
Mondor's Disease (MD) is a rare condition characterized by thrombophlebitis of the superficial veins. It is more common in women between the third and fifth decades and most commonly found in the vessels of the thoraco-abdominal wall (3). The vessels most commonly affected are the thoraco-epigastric, lateral thoracic, and superior epigastric veins (4). However, it has also been described in vessels of the antecubital fossa, penis, groin, or posterior neck (1). MD presents with acute onset of induration in a cord-like pattern with the absence of peri-venous inflammatory changes (2). This area of induration is often asymptomatic. But, some patients do report pain. MD can be diagnosed via history and physical exam. However, ultrasound can confirm the diagnosis if needed (2). The etiology of MD is unclear. It can be idiopathic although most cases have been described in the setting of significant trauma such as breast surgery. Some reports have described associations with other underlying conditions, namely breast cancer or hypercoaguble states (1). MD is a self-limited condition and treatment consists of symptom management with rest, NSAIDs, warm compresses, and breast support.

Editor's Comments:
The treating team did a through job of excluding the other acute causes of chest pain. It has been reported in the literature that the pathophysiology of Mondor's disease is due to the pro-inflammatory state and muscle damage done during exercise (5). One of the key findings in clinical history may be the upper body work out.

References:
1. Alvarez‐Garrido, H, A. A. Garrido‐Rios, C. Sanz‐Munoz, A. Miranda‐Romero, Mondor's disease, Clinical and Experimental Dermatology, Volume 34, Issue 7, 1 October 2009, Pages 753–756

2. Laroche, J.P, et al. Mondor's disease: What's new since 1939?. Thrombosis Research. October 2012; 130 (1): S56-S58.

3. Toshiyuki Yamaguchi, MD. Mondor disease of the breast. Cleveland Clinic Journal of Medicine July 2022, 89 (7): 371-372

4. Wong, SN, et al. Mondor's disease: sclerosing thrombophlebitis of subcutaneous veins in a patient with occult carcinoma of the breast. Hong Kong Medical Journal. June 2017; 23(3):311–2

5. Hemsing, Anette Lodvir, and Hakon Reikvam. "Mondor's disease after extensive training with Nordic walking." Oxford Medical Case Reports 2019.8 (2019): omz075.

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