Cesar Mora Jaramillo, MD, FAAFP, FCUCM
Case Presentation
Patient is a 29-year-old Male, who presents to Urgent Care with several months of penile shaft “lump”. He describes the lump as firm cord that might be increasing in size over the past one month. He denies pain but reports mild discomfort. Additionally, patient denies penile discharge or genital lesions. No past medical history of Sexual transmitted diseases and he denies any high-risk sexual behavior.
On physical exam: patient is in no acute distress; vital signs are normal. Abdomen is not distended, non-tender and bowel sounds are present. Penis is circumcised, a small firm – mobile cord is palpated on the midshaft dorsum of the penis. Non tender, no edema, no erythema. No groin lymphadenopathy. No penile discharge or lesions. Testicular exam was normal.
Differential diagnosis
Peyronie’s Disease
Sclerosing lymphangitis
Mondor’s Disease
Penile Carcinoma
Diagnosis
Mondor’s Disease is a rare and self-limiting, benign process. The chest, abdominal wall, penis, upper arm and other parts of the body may also be involved by the disease.
Penile Mondor’s Disease is thrombophlebitis of the superficial dorsal vein of the penis. Although some findings suggest that it might be of lymphatic origin, it may be associated with psychological distress and sexual incompatibility. Early and accurate diagnosis increases efficiency of the medical treatment.
The patient was referred for ultrasound that showed multiple dilated superficial veins along the right side of the penile shaft consistent with superficial varicosities. Several are incompressible and contains echogenic material consistent with superficial thrombophlebitis.
Pearls for Urgent Care Management
Patients usually present with the feeling of a hard rope/thick cord.
Affects sexually active men of any age.
Causes of the disease include frequent, severe and prolonged sexual intercourse, penile trauma, prolonged abstinence, local (syphilis, candida) or distant infections, sexual transmitted diseases, thrombophilia, among other conditions.
Sudden and painful or painless cord induration is the commonest presentation.
Doppler ultrasound is important for diagnosis.
Laboratory tests are often not necessary.
Patients usually recover within 4-6 weeks without any treatment.
Sexual activity should be restricted in addition to the use of anticoagulant agents.
Anti-inflammatory drugs are commonly prescribed for this condition.
Referral to urology should be considered for medical treatment that includes creams containing heparin or surgery for refractory cases.
Prognosis is good. There are no reports of erectile dysfunction or penile deformity after treatment.
References:
Öztürk H. Penile Mondor’s disease. Basic Clin Androl. 2014;24:5. Published 2014 Mar 3. doi:10.1186/2051-4190-24-5
Diffuse swelling of the penis in a young adult. Postgraduate Medical Journal. https://pmj.bmj.com/content/76/895/311.3. Published May 1, 2000. Accessed October 16, 2021.
Al-Amiri A. Mondor’s disease of the penis. Research. http://www.research-journal.net/en/Mondor-s-Disease-of-the-Penis.html. Published September 2, 2015. Accessed October 16, 2021.