Penile Mondor’s disease: imaging in two cases.
Penile Mondor’s disease
Two men aged 46 and 51 respectively, came to our observation complaining of a swelling and pain of the suprapubic region and the dorusm of the penis, sent by their family doctors for the execution of an ultrasound examination aimed at excluding inguinal hernias or testicular pathologies. Both presented with complaints of penile pain during sexual intercourse, and they had experienced this pain for several weeks. There was no evidence of penile discharge, hematuria, dysuria, fever or erectile dysfunction, and they denied any recent vigorous sexual activity or a history of any type of trauma. On the physical examination, a cord-like induration was palpated in the dorsal aspect of the penis and this was associated with tenderness and overlying skin erythema.Ultrasound of the penis demonstrated a non-compressible superficial dorsal vein with internal echogenicity and Color Doppler ultrasound demonstrated a lack of endoluminal flow signals.One of them performed an unenhanced pelvic CT showing a cord-like hyperdense thickening in the dorsal subcutaneous soft tissues of the penis corresponding to the thrombosis of the respective vein. Faded surrounding edema was associated. Sexual abstinence, heparin ointment, and oral non-steroidal anti-inflammatory drugs (NSAIDs) were adopted as conservative therapy and both patients recovered totally in 4-8 weeks. Penile Mondor’s disease is a rare and under-recognized benign genital condition consisting in an isolated thrombosis of the dorsal superficial vein of the penis. Symptoms don’t show distinctive features and there are asymptomatic cases. The patients usually present with an hardness like a rope at dorsum of the penis. Diagnosis is usually made based on history and physical examination. The role of imaging in Mondor’s disease is to identify the intravascular thrombus. Grey scale and Doppler ultrasound can be useful in case of diagnostic uncertainty, to detect the extent of thrombosis demonstrating echogenic material within venous lumen, impossibility of vessel compression and absence of flow, as well as painful selective pressure. The use of Magnetic Resonance is controversial and not used routinely. Usually treatment is conservative: sexual rest, local anesthetics, anti-inflammatories, antibiotics in case of infection and anticoagulants. Sclerosing lymphangitis and Peyronie’s disease have been emphasized in differential diagnosis. Penile Mondor’s disease is a rare and under-recognized benign genital condition consisting in an isolated thrombosis of the dorsal superficial vein of the penis. The patients usually present with an hardness like a rope at dorsum of the penis. Diagnosis is usually made based on history, physical examination and Color-Doppler ultrasound. This disease is usually self-limiting and conservative treatment is the therapy of choice.