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Penile Mondor's Disease, Mondor's Disease, superficial thrombophlebitis, sclerosing lymphangitis, Peyronie's disease
A 55-year-old male complained of a five day history of a firm, painful, cord-like area on his penis. Physical exam was significant for a palpable, hard, serpiginous cord on the dorsal shaft. Ultrasound of the cord showed thrombosis of the penile vein. Similarly, a 27-year-old male complained of a one month history of a painful bump on his penis. Physical exam was significant for a firm, painful cord over the dorsum of the penile shaft.
Both patients had penile Mondor's disease (PMD). Penile Mondor’s disease is defined as a superficial thrombophlebitis of the penile dorsal vein. Although the most common cause of PMD is trauma due to frequent and prolonged sexual intercourse, other risk factors include infections, surgery, cancer, and Virchow's triad.
The typical PMD patient is a 20 to 40-year-old male who presents with a firm, cord-like lesion on the dorsum of the penis 24 to 48 hours after prolonged sexual activity. The thrombosed vessel is often adherent to the overlying skin, and the thrombosis can extend to the suprapubic region. Patients may complain of continuous throbbing pain or pain exacerbated by erection. Color doppler ultrasound is necessary to confirm the diagnosis; it will show occlusion of the dorsal vein and absent flow signals. Color doppler ultrasound will also differentiate PMD from sclerosing lymphangitis of the penis and Peyronie's disease. Treatment includes anti-inflammatory agents and restriction of sexual activity. Patients often recover within four to six weeks and regain vessel permeability within two months.
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