Subcutaneous emphysema of the scrotum (pneumoscrotum)
High speed motor bike accident. Extensive subcutaneous emphysema, bilateral pneumothorax, and multiple rib fractures. Intubated and finger thoracostomy at the scene.
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Extensive subcutaneous emphysema as a result of blunt traumatic pneumothorax, gas tracking through the inguinal canal and Scarpa’s fascia, resulting in subcutaneous emphysema of the scrotum, otherwise known as pneumoscrotum.
Pneumoscrotum is a rare injury associated with traumatic pneumothorax following blunt trauma 1. Free air migrates inferiorly into the paranephric space, through the retroperitoneum and into inguinal canal 2.
The three common pathways that result in air tracking into the scrotum are:
- free air in the abdomen through a patent processus vaginalis
- retroperitoneal air into the inguinal canal tracking down the superficial fascia covering the spermatic cord
- direct extension of the subcutaneous emphysema of the trunk via the path of least resistance 3.
The clinical significance is relatively low as the associated injuries are of higher importance, and management is often conservative 4.
- 1. Simaioforidis V, Kontos S, Fokitis I et-al. Subcutaneous emphysema of the scrotum (pneumoscrotum) due to traumatic pneumothorax: a case report. Cases J. 2008;1 (1): 293. doi:10.1186/1757-1626-1-293 - Free text at pubmed - Pubmed citation
- 2. Stavem K, Høivik B. Pneumoscrotum after air leak from tension pneumothorax. Tidsskr. Nor. Laegeforen. 1996;116 (10): 1214-5. Pubmed citation
- 3. Casey RG, Al-Dousari S, Murphy D et-al. Chest drain insertion may result in the acute scrotum. Scand. J. Urol. Nephrol. 2006;40 (1): 78-9. doi:10.1080/00365590500522718 - Pubmed citation
- 4. Millmond SH, Goldman SM. Pneumoscrotum after spontaneous pneumothorax with air leak. J. Urol. 1991;145 (6): 1271-2. Pubmed citation