A 34-year-old woman notices a painful cord-like structure running vertically from the lower pole of the left breast to the epigastrium. Examination confirms a tender subcutaneous band with overlying skin dimpling on arm abduction, and no discrete breast lump. The best initial management is:

• A Low molecular weight heparin for 3 months
• B Excision biopsy of the cord to exclude malignancy
• C Analgesia and reassurance, as it resolves spontaneously in 4 to 6 weeks ✓
• D Oral antibiotics covering staphylococci

Explanation

This is Mondor disease, a thrombophlebitis of the thoracoepigastric or superior epigastric veins presenting as a tender palpable cord that becomes prominent on stretching or abduction. It is a self-limiting benign condition managed with analgesics and resolves within 4 to 6 weeks. Anticoagulation is unnecessary because this is a superficial vein of the chest wall rather than deep venous disease, and antibiotics treat infection, not sterile thrombosis. Any associated breast lump must still be assessed separately.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.