AJR 2002; 179:185-186
© American Roentgen Ray Society
Stereotactic Vacuum-Assisted Breast Biopsy: An Unusual Cause of Mondor's Disease
Maryam Jaberi1,
Shawna C. Willey1 and
Rachel F. Brem2
1 Department of Surgery, The George Washington University Medical Center, 2150
Pennsylvania Ave., N.W., Washington, DC 20037.
2 Department of Radiology, Breast Imaging and Intervention, The George
Washington University Medical Center, Washington, DC 20037.
Received October 4, 2001;
accepted after revision December 7, 2001.
Address correspondence to R. F. Brem.
Introduction
Mondor's disease is a rare condition characterized by thrombophlebitis of
the superficial veins of the breast and chest wall. It is a benign and
self-limited problem associated most commonly with trauma and breast surgery.
However, to our knowledge, stereotactic vacuum-assisted biopsy of the breast
has not been reported in the literature as a cause of Mondor's disease.
Case Report
A 55-year-old woman presented for stereotactic core needle biopsy of
indeterminate microcalcifications noted on a mammogram in the 4-o'clock
position of the left breast. The procedure was uneventful. She returned in 23
days with left lateral breast tenderness. The second mammogram was
unremarkable. However, the sonogram showed a beaded superficial vein that was
not compressible during scanning (Fig.
1A,1B),
characteristic of Mondor's disease. The patient was treated with warm
compresses and nonsteroidal antiinflammatory medication, and she recovered
uneventfully. The pathologic finding of the biopsy revealed ductal ectasia and
benign breast disease.
Discussion
The French surgeon Henri Mondor was the first to fully describe a
superficial thrombophlebitis of the anterior thoracoabdominal wall in 1939
[1]. The presenting symptoms of
Mondor's disease include pain, tenderness, and occasional redness along the
involved vein. Many causes such as trauma, surgical biopsy, infection,
underlying occult benign or malignant breast disease, muscular strain, tight
clothing, radiation, and a large pendulous breast have been reported
[1,2,3,4].
Although there are many causes, Mondor's disease is rarely observed. In one
series, an incidence of less than 1% per year was reported after open surgical
breast biopsy [5].
Mondor's disease presents with a sudden onset of localized pain in the
breast followed by palpable and visible cutaneous grooves that are cordlike
and sometimes branching. These cords can be 3-5 mm in diameter and 5-30 cm in
length [6]. The commonly
involved veins are the thoracoepigastric, lateral thoracic, and superior
epigastric. Superficial veins that run obliquely over the lateral chest wall
to the anterior axillary line are usually affected
[1]. These veins extend
inferiorly onto the abdomen, and this finding aids in the diagnosis. The
symptomatic and visible course of the disease is between 2 and 8 weeks
[4].
Mondor's disease has been reported in patients with no risk factors who
were found to have breast cancer at physical examination or on imaging.
Catania et al. [7] found breast
cancer in 12.7% of a series of 63 such patients. Whereas one report
[7] suggested a greater
incidence of breast cancer in patients with Mondor's disease but with no
identifiable risk factors, another report
[5] suggested a lower
incidence. At present, no clear consensus exists.
The mammographic features of Mondor's disease have been reported
[8]. A long, thickened,
ropelike density is visible in the periphery of the mammogram corresponding to
the superficial position of the vein. Reports of sonographic findings of this
condition are also rare. Sonography shows a hypoechoic, noncompressible
tubular structure with variable width associated with a palpable cord
[8].
In the absence of a proven pathophysiologic mechanism, a multificatorial
phenomenon has been postulated to explain the occurrence of Mondor's disease.
For example, a breast mass, inflammatory parenchyma, or fat necrosis of the
breast can exert pressure on the lateral thoracic vein that results in stasis
of blood. Direct trauma to the vein during biopsy is another mechanism
[7]. Hou et al.
[5] reported on the surgical
causes of Mondor's disease and found a greater incidence when excisional
biopsies were tunneled more than 3 cm from the areolar edge to the lesion.
Hence, those authors concluded that tunneling should be avoided during breast
biopsy.
In our patient, we postulate that the needle caused direct trauma to the
vein. Because stereotactic vacuum-assisted biopsy is becoming more
commonplace, Mondor's disease should be recognized in the patient who has a
sudden onset of localized breast pain and a palpable cordlike cutaneous groove
after biopsy. Conservative treatment with warm compresses, breast support, and
analgesics usually allows resolution within 2-8 weeks
[4].
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AJR
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Introduction
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