Sonographically Detectable Idiopathic Axillary Web Syndrome With Concurrent Thrombophlebitis: A Case Report

Axillary web syndrome (AWS), also known as Mondor Disease, is a self-limiting condition characterized by axillary pain radiating down the anteromedial upper extremity with an associated decrease in shoulder abduction and overlying palpable cords. AWS is commonly seen in female patients with a history of axillary clearance (AC), though it is also associated with patients who have undergone sentinel lymph node biopsy (SLNB), mastectomy, or radiation therapy to the axilla or breast. AWS is a significant cause of morbidity in such patients. While the exact pathophysiology is not entirely understood, AWS is thought to arise from a complex interplay of disruptions in lymphatic flow and connective tissue fibrosis following the interventions described. We present a unique case of AWS with concurrent thrombophlebitis in a 25-year-old male who presented to the ED with a two-day history of right axillary pain and no past medical or surgical history. On physical examination, the patient showed decreased range of motion (ROM) in abduction of the right upper extremity (RUE) with an overlying palpable cord-like structure at the proximal medial RUE. Following a Doppler ultrasound (US), a diagnosis of AWS with concurrent superficial thrombophlebitis was made. This case highlights the importance of considering AWS in patients without a suggestive medical history, along with the potential utility of US in approaching a diagnosis.