Penile Mondor disease is a benign self-limiting condition of the penis characterized by thrombophlebitis of the superficial dorsal vein of the penis or one of its tributaries.
Mondor disease also occurs in the breast and axilla.
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Epidemiology
It usually occurs in sexually active young adults. The etiology is usually unknown, but various risk factors have been reported 5.
Risk factors
penile trauma from forceful, prolonged, or excessive sexual activity (the main risk factor)
prolonged sexual abstinence
constrictive elements used during certain sexual practices
infections (syphilis, candida)
surgery of the pelvis or external genitalia
pelvic cancers
cancer-associated thromboembolism
hypercoagulable state
Clinical presentation
Patients usually present with cord-like induration along the dorsum in the location of the dorsal vein and soft tissue swelling. Many patients experience pain or discomfort, especially with erection 1.
Radiographic features
Ultrasound
Color Doppler ultrasonography is the modality of choice for diagnosis. The diagnosis is considered if there is non-compressibility of the dorsal vein indicating thrombosis. Internal echogenicity varies according to the age of the thrombus; acute thrombus may be anechoic while subacute cases usually show a hyperechoic heterogeneous appearance. No flow is present inside the vein on color or spectral Doppler studies.
On color Doppler with an intracavernosal vasoactive agent, the cavernosal artery can be normal or show a high flow resistance pattern similar to low-flow priapism 2, but this examination carries a high risk of priapism 6.
MRI
MRI is rarely needed. The MR signal intensity varies depending on the age of the thrombus.
Treatment and prognosis
Mondor disease is a benign, self-limiting condition. Treatment is the same as for superficial venous thrombosis, including applying a local warm dressing and administering anti-inflammatory drugs like NSAIDs, antibiotics and low-molecular weight heparin (LMWH) 1,7. Symptoms usually resolve after 6-8 weeks of treatment with anti-inflammatory drugs. Direct oral anticoagulants can be tried in cases not responding to LMWH 7. Surgery with thrombectomy and resection can be performed for refractory cases 5.
History and etymology
Mondor disease was initially described by Henri Mondor (1885-1962) in 1939 as "sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall".
Braun-Falco described phlebitis of the dorsal veins of the penis within the context of generalized phlebitis in 1955 3. Then Helm and Hodge first described isolated penile Mondor disease in 1958 4.
Differential diagnosis
sclerosing lymphangitis of the penis: seen as serpiginous thickened and dilated lymphatic vessels
peyronie disease: presents as a well-defined fibrotic plaque on the penis
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