Penile Mondor disease (superficial venous thrombosis of the dorsal vein)

Clinical History

A healthy patient came to the emergency department complaining of pain and foreign-body sensation along the dorsum of the penis, aggravated with erection. There was no history of trauma, fever or lower urinary tract symptoms. Physical examination revealed a cord-like painful swelling in the dorsum of the penis.

Imaging Findings

Gray scale ultrasound (US) of the penis revealed internal echogenicity in the superficial dorsal vein (Fig. 1).
Colour Doppler US showed an absence of venous flow and noncompressibility of a distended penile superficial dorsal vein, findings that suggest thrombosis. The penile dorsal arteries were patent. (Fig. 2 and 3).

Discussion

Superficial venous thrombosis is a well-known condition, which was first described by Mondor in 1939 [1]. The most commonly affected vessels are the thoracoepigastric, lateral thoracic, and superior epigastric veins, therefore clinical findings have been usually founded in the breast, axilla, groin and posterior cervical region. Isolated penile Mondor disease was first described in 1958 by Helm and Hodge [2].
Penile Mondor disease is an unusual condition [3-5] characterized by thrombosis or thrombophlebitis in the superficial dorsal vein of the penis that affects sexually active young men. The aetiology of this condition is poorly understood, but vigorous or prolonged sexual activity, trauma, surgery of the pelvis or external genitalia, pelvic tumours, injection of illegal substances into the dorsal vein, prolonged abstinence and hypercoagulable states have been suggested [3-8].
Diagnosis can be established from history and physical examination but colour Doppler US still plays an important role in the confirmation and monitoring of penile venous thrombosis [6, 7]. Magnetic resonance imaging is not routinely used or necessary to diagnose this condition and should be reserved for complex cases to exclude deep pelvic extension of vein thrombosis, or overlapping of a concomitant thrombosis in another pelviperineal vein district [6].
Penile Mondor disease is self-limited with resolution in 6-9 weeks [3-7].
Treatment is identical to superficial venous thrombosis elsewhere in the body, including local warm dressing and oral nonsteroidal anti-inflammatory drugs. Abstinence from sexual intercourse is usually recommended [3, 4, 6].
Follow-up physical examination and ultrasound are usually recommended to confirm resolution of symptoms and document normal venous flow in the dorsal vein of the penis [3].

Differential Diagnosis List

Final Diagnosis

Penile Mondor disease

URL:	https://www.eurorad.org/case/12267
DOI:	10.1594/EURORAD/CASE.12267
ISSN:	1563-4086