Pneumoscrotum: a complication of pneumatosis intestinalis

A 12-year-old immunosuppressed boy presented with self-limiting abdominal pain, low-grade fever and progressive scrotal swelling. Relevant recent medical history included recurrent pneumatosis intestinalis secondary to bone marrow transplantation for relapsed non-Hodgkin lymphoma.

Abdominal radiograph (ESM Fig. 1) shows extensive bowel pneumatosis with evidence of retroperitoneal and scrotal gas. Pelvic CT (Fig. 1, CTDI = 8.99 mGy) shows widespread pneumatosis intestinalis with both peritoneal and retroperitoneal gas and marked surgical emphysema extending into the perineum and scrotal wall (scrotal emphysema, long arrow). Further intra-scrotal gas appears intimately related to the right testicle (scrotal pneumatocoele, dashed arrow).

Fig. 1
figure1

Pelvic CT

The term pneumoscrotum describes the presence of air in the scrotal soft tissues originating via one or more of three described routes [1]:

  1. 1.

    Scrotal emphysema: extraperitoneal air dissecting through fascial layers into the scrotal wall

  2. 2.

    Scrotal pneumatocoele: intraperitoneal air entering the scrotum via patent processus vaginalis [2]

  3. 3.

    Gas gangrene/local trauma: local production of scrotal gas/air

References

  1. 1.

    Watson HS, Klugo RC, Coffield KS (1992) Pneumoscrotum: report of two cases and review of mechanism of its development. Urology 40:517–521

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  2. 2.

    Bray JF (1982) Pneumoscrotum with testicular delineation—a new sign of pneumoperitoneum. Br J Radiol 55:867–868

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Correspondence to Chirag Patel.

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Suppl Fig. 1
figure2

Plain abdominal radiograph (GIF 62 kb)

High resolution (TIFF 37,832 kb)

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Patel, C., Barnacle, A.M. Pneumoscrotum: a complication of pneumatosis intestinalis. Pediatr Radiol 41, 129 (2011). https://doi.org/10.1007/s00247-010-1706-7

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Keywords

  • Bone Marrow
  • Lymphoma
  • Abdominal Pain
  • Nuclear Medicine
  • Bone Marrow Transplantation