Pneumoscrotum with extensive subcutaneous emphysema in traumatic perineal injury: A case report

Key Clinical Message

We present a rare case of pneumoscrotum with subsequent subcutaneous emphysema in penetrating perineal injury with a tangential wound. It is important to diagnose the underlying disease and treat the cause. An examination under anesthesia is crucial for the diagnosis and management of the set of injuries.

Abstract

Pneumoscrotum with subcutaneous emphysema in traumatic perineal injuries is an alarming sign and may indicate life-threatening intraabdominal injuries or necrotizing fasciitis. We reported a case of pneumoscrotum and extensive subcutaneous emphysema of the abdomen and chest 2 days after admission. Pneumoscrotum was not seen on the initial Computerized tomographic scan.

Emphysematous epididymo-orchitis: An unusual case report

Introduction

Emphysematous epididymo-orchitis in the young to middle age groups without any comorbidity like diabetes or metabolic disorders is an uncommon entity.

Case report

We present a case of a nondiabetic young patient, diagnosed with emphysematous epididymo-orchitis as a sequela to urinary tract infection.

Discussion

Clinically differentiating diagnoses of the acute scrotum may be difficult and ultrasound can be used reliably as the initial modality showing the presence of air for early diagnosis.

Conclusion

Nondiabetic young patients without any metabolic disorder should also be suspected for emphysematous epididymo-orchitis in the setting of the acute scrotum. An ultrasound examination can predict its presence with confidence.

Pneumoscrotum Caused by a Bronchopleural Fistula

Pneumoscrotum is the term used to indicate the presence of air in the scrotum and comprises scrotal emphysema and pneumatocele. It is an uncommon medical condition and encompasses multiple etiologies, some of which may be life-threatening. We present the case of a 45-year-old male who developed a pneumoscrotum seven days after undergoing a thoracoscopy with decortication, pleural biopsy, and chest tube insertion, for a loculated pleural effusion not amenable to drainage by a pigtail catheter. The patient was diagnosed with a bronchopleural fistula and was treated conservatively with negative chest tube pressure. Treatment of the fistula and of the resulting pneumothorax allowed resorption of the pneumoscrotum. The associated literature is reviewed after the case presentation. This case report underlines the importance of evaluating a pneumoscrotum that should not be underestimated.

Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma

Pneumoscrotum is a rare complication that can result from various etiologies and can be essential in the diagnosis of those causative factors, especially life-threatening ones such as infection or trauma. We present here a case of a patient who presented in posttraumatic cardiac arrest and an extensive, grossly obvious, and rapidly expanding pneumoscrotum. Based on our patient's clinical presentation and a history of a high-speed mechanism with obvious torso trauma, a diagnosis of tension pneumothorax was quickly made resulting in immediate treatment. We review the existing literature and highlight the importance of pneumoscrotum in aiding with differential diagnosis. The presence of pneumoscrotum is often benign; however, in the right clinical setting, it can be an extremely important and useful clinical tool for the early identification and timely treatment of life-threatening diagnoses, such as tension pneumothorax.

Pneumoscrotum after colorectal surgery: A case report

Pneumoscrotum is a very rare complication. Currently, very little evidence-based medicine exists on treatment guidelines. We think a prophylactic antibiotic course and a 48 hours in hospital observation are justified in these rare cases.

Pneumoscrotum: report of two different cases and review of the literature

Pneumoscrotum is the term used to describe the presence of air within the scrotum and includes scrotal emphysema as well as pneumatocele. The etiology varies; in some cases, pneumoscrotum may be due to life-threatening disease like pneumothorax or Fournier gangrene. Despite this, pneumoscrotum is a rarely debated issue. We present two different cases of pneumoscrotum and a review of the literature. The first case report is about a 29 year old male patient affected by Duchenne syndrome who showed pneumoscrotum after cardiopulmonary resuscitation that was performed for asphyxic crisis and cardiovascular arrest. We carried out local puncture with an 18-gauge needle, and the pneumoscrotum was successfully solved. The second case report is about a 56 year old male with pneumoscrotum due to Fournier gangrene who underwent radical exeresis of all necrotic tissues and drainage. This is why most of the scrotal skin and all of the penis skin were removed; as a result, the testicles, epididymis, and cavernosa corpora were externalized. On postoperative day one, the patient was feverless and underwent hyperbaric chamber therapy. No postoperative complications occurred. Accurate evaluation of the pneumoscrotum is always needed. Despite the benign course of most of the clinically evident pneumoscrotum cases, this condition should never be underestimated.

Pneumoscrotum after tracheal intubation

Air in the scrotum is an unusual clinical finding and a thorough search should be done in order to locate the air leak or source of gas production. We report an 81-year-old patient who developed severe acute respiratory failure after fiberoptic bronchoscopy and was intubated immediately. After tracheal intubation, excessive subcutaneous emphysema from the head to the scrotum was obvious. Chest tube thoracostomies were placed to treat pneumothorax. The emphysema was absorbed after 13 days without any sequela. Air or gas inside the scrotum may originate from intraperitoneal, extraperitoneal, or local sources. The majority of the cases can be managed conservatively, but emergent intervention is needed in life-threatening situations.