Post-Traumatic Penile Lymphangitis Following Prolonged Constriction

Case at a Glance

A 50-year-old Hispanic male presents with a palpable cord-like structure along the dorsal penile shaft and a firm nodule at the penile base, developing approximately one month after prolonged penile constriction with improvised material during sleep.

Patient's Story

The patient reports using kitchen twine as an improvised penile constriction device approximately two months prior to presentation. He inadvertently fell asleep with the device in place, awakening with mild pain and numbness. Since the incident, he has noticed progressive development of a cord-like structure along the dorsal penile shaft, most prominent during erection and sexual activity. He also reports a firm, palpable nodule at the penile base corresponding to the original constriction site. Symptoms include mild soreness during erection and ejaculation, with the cord-like structure remaining palpable but less prominent when flaccid.

Initial Assessment

Physical examination revealed a linear, cord-like induration along the dorsal penile shaft and a firm nodule at the penile base. The patient reported mild tenderness on palpation and increased prominence during tumescence. No signs of infection, necrosis, or severe vascular compromise were noted.

The Diagnostic Journey

Given the clinical presentation and history of prolonged penile constriction, the differential diagnosis included sclerosing lymphangitis (lymphangiosclerosis), superficial thrombophlebitis, or post-traumatic fibrosis. The timeline and characteristic appearance strongly suggested lymphatic vessel involvement secondary to trauma.

Final Diagnosis

Sclerosing lymphangitis (lymphangiosclerosis) secondary to prolonged penile constriction injury

Treatment Plan

Conservative management with activity modification, including temporary reduction in sexual activity and masturbation frequency. Anti-inflammatory medication (ibuprofen) for symptomatic relief. Warm compress application to promote lymphatic drainage. Patient education regarding proper use of commercial penile enhancement devices with appropriate sizing and time limitations (maximum 30 minutes).

Outcome and Follow-up

The condition is expected to resolve spontaneously over several months with conservative management. Long-term follow-up cases report gradual improvement, with some patients experiencing complete resolution within 5-6 months, though mild residual changes may persist. The patient was counseled on the benign nature of the condition while emphasizing the importance of avoiding improvised constriction devices in the future.