OmniBlog

Last week I saw a middle-aged man who complained of pain over the right anterior chest. He had done some heavy exertion a few days earlier (extreme Yoga). While examining the painful area of chest, I noticed a feeling of something under the skin. On more careful palpation, it was a vertical cord-like swelling, just under the skin. On making the patient raise his right arm above the head, the swelling became visible too. Check the photograph on the right. You can see a longitudinal swelling with depression near it too.

Any guesses on the diagnosis?













Mondor’s Disease, also called “string phlebitis”

Mondor’s Disease is a rare condition of sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall. Commonly involved veins are lateral thoracic, thoracoepigastric, and superior epigastric veins. This idiopathic condition that is 3 times more common in females is characterized by a tough, fibrous band that is accompanied by tension and skin retraction. The skin retraction is pronounced on raising the hands as described in a case of subcutaneous cord-like structure over the chest.

It can be caused either by pressure on the veins resulting in stagnation, or due to direct trauma to the vein itself.

The condition is known to subside spontaneously in a few weeks. The time course is reported to be between 2 weeks and a few months. A fibrous cord may be evident for as long as a year.

The patient needs to be reassured about the benign nature of the condition and adviced to apply local warmth. Anti-inflammatory agents like ibuprofen may be useful to relieve pain.