Clinical History
A physically healthy 38-year-old man presented to our department suffering from a painful swelling, on the dorsal aspect of his penis. This swelling had appeared 5 days before and was more painful during erections. There was no history of erectile dysfunction, trauma, recent surgery, recent extensive sexual activity or symptoms from the lower urinary tract.
Imaging Findings
Ultrasound revealed a dilated, noncompressible superficial dorsal penile vein as well as the lack of venous flow signals in Doppler ultrasound. There was flow signal in both of the dorsal penile arteries. The patient was treated with nonsteroidal anti-inflammatory drugs and about 35 days after the first episode of pain, the swelling disappeared and he had no symptom. Doppler ultrasound of the superficial dorsal penile vein demonstrated the presence of normal blood flow.
Discussion
Penile Mondor’s disease is a benign condition involving the superficial dorsal vein of the penis, affecting sexually active men.
The aetiopathogenesis of penile Mondor disease is still controversial. Events that precipitate this disorder include excessive sexual activity, prolonged sexual abstinence, infection, venous compression due to a tumour or distended bladder, injection of illegal drugs into the penile dorsal vein, deep venous thrombosis of the leg, trauma, migratory phlebitis associated with cancer, and surgical repair of an inguinal hernia. All these factors relate to Virchow’s triad of vessel wall damage, stasis and some hypercoagulable state [1].
On clinical examination the dorsal surface of the penis is red swollen and the cord like superficial dorsal vein of the penis is usually palpable and painful.
Doppler ultrasound reveals a dorsal induration corresponding to segmental thrombosis of the superficial dorsal vein of the penis.
Mondor's disease is usually self-limited, benign and recovery may take three weeks to six months. Local dressing with heparin ointment and oral treatment with non-steroidal anti-inflammatory medication are used for acute discomfort.
Doppler ultrasound is useful in both the diagnosis and follow-up of these patients to visualise resolution of the thrombosis and appearance of normal blood flow during and after treatment [2].
Differential Diagnosis List
Penile Mondor's disease (superficial dorsal vein thrombophlebitis).
Sclerosing lymphangitis
Peyronie’s disease
Final Diagnosis
Penile Mondor's disease (superficial dorsal vein thrombophlebitis).
