Thrombophlebitis of the superficial dorsal penile vein following a long-haul flight: a case report of penile Mondor's disease without classical risk factors

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Penile Mondor's disease (PMD) is a rare, typically self-limiting superficial thrombophlebitis of the dorsal penile vein. Common risk factors include intensive sexual activity, penile trauma, and coagulation disorders. We report the first documented case of PMD occurring after a long-haul flight associated with prolonged immobilisation. A 29-year-old male patient presented with an acute, painful swelling of the penile shaft following a transatlantic long-haul flight. Clinical examination revealed a cord-like induration along the dorsal penile vein. Doppler ultrasonography demonstrated a 4 cm-long hypoechogenic structure within the superficial dorsal penile vein, with no detectable venous flow signals in this region. Subsequent magnetic resonance imaging ruled out involvement of the deep penile vein, the external pudendal veins, and the pelvic veins. Conservative management with nonsteroidal anti-inflammatory drugs, topical heparin ointment application, and anticoagulation with low-molecular-weight heparin - later transitioned to an oral factor Xa inhibitor - resulted in complete remission within four weeks. This case underscores the importance of early diagnosis and conservative management of PMD. Prolonged immobilisation should be recognised as a potential risk factor. Prophylactic administration of low molecular weight heparin prior to long-haul flights may be considered in at-risk patients.