COVID-19 Era: Mondor’s disease and Rembrandt. What ties?

Abstract

The recent and increased number of scientific reports on venous thrombosis and venous thromboembolism induced by corona- virus, suggests to improve our level of attention because thrombophlebitis could be a clinical manifestation of COVID-19. We need to be aware also of rare varieties of venous thrombosis such as Mondor disease. The comparison between the enigmatic breast discoloration of the Bathsheba painted by Rembrandt and a case of Mondor disease observed in 2020, becomes a cultural game to improve our clinical skills in diagnosing Mondor thrombophlebitis.

Mondor’s disease of the penis due to asymptomatic infective prostatitis provoking episodes of secondary sclerotizing lymphangitis

“…1 Although no formal classification has yet been established, MD on the anterolateral thoracoabdominal wall is generally recognized as original MD, while similar abnormalities on other sites, such as the penis and axilla, are recognized as variants of MD. 2 The former is called penile MD (first reported by Helm et al, in 1958 3 ) and the latter is called axillary web syndrome (first reported as a complication of axillary surgery by Moskovitz et al in 2001. 4 Almost all cases of MD are reported to be thrombophlebitis of the superficial vein, although some are reported to be lymphangitis and/or a combination of both the etiologies.…”

“…5 MD occurs with a palpable, subcutaneous, painless or tender, cord-like induration, beneath the skin on the chest wall along front axillary line. 2 In most cases the superficial thickening corresponds to the route of the thoraco-epigastric vein and is caused by a superficial thrombophlebitis. 6 The thoraco-epigastric vein connects the superficial epigastric vein and the lateral thoracic vein, and therefore drains into both the superior vena cava via the axillary vein and the inferior vena cava via the femoral vein.…”

“…Endothelial dysfunction, stasis of blood flow and hypercoagulability (due to excessive inflammation or platelet activation), also known as Virchow's triad may predispose patients to thrombotic disease, both in the venous and arterial circulations. 2 A history of deep venous thrombosis of the leg, migratory phlebitis associated with cancer, and surgical repair of an inguinal hernia can be considered risk factors. 10 In the literature is also reported a case of penile Mondor's disease, that has occurred after a long-haul flight, which required to maintain a sitting position for a long time.…”

Superficial Thrombophlebitis of the Breast (Mondor’s Disease): An Uncommon Localization of Common Disease

“…Clinicians should also be aware of rare forms of venous thrombosis such as Mondor's disease. 26 In most cases, a proper explanation of the condition, strong reassurance and symptomatic treatment with anti-inflammatory drugs and warm compresses are helpful and lesion resolves completely within 2-8 weeks. 1,2,25 Cases with cord-like lesions on the chest wall were initially reported in the early 1850s, but this condition was acknowledged by and named after Henri Mondor, a French surgeon who reported a series of four cases and thoroughly described them in 1939.…”

Iron wire phlebitis – a disease of underestimated significance. COVID-19 as a factor increasing the risk of Mondor's disease

“…Hence, physicians should remain vigilant and have a heightened awareness of both common and less common cases of thrombosis in individuals, including Mondor's disease. [7,11] 15 Given the characteristic image on examination, the ultrasound findings, and the predisposing factors, the diagnosis of Mondor's Disease was made. However, the patient was kept under observation with increased oncological vigilance.…”