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).
The term pneumoscrotum describes the presence of air in the scrotal soft tissues originating via one or more of three described routes :
Scrotal emphysema: extraperitoneal air dissecting through fascial layers into the scrotal wall
Scrotal pneumatocoele: intraperitoneal air entering the scrotum via patent processus vaginalis 
Gas gangrene/local trauma: local production of scrotal gas/air
Watson HS, Klugo RC, Coffield KS (1992) Pneumoscrotum: report of two cases and review of mechanism of its development. Urology 40:517–521
Bray JF (1982) Pneumoscrotum with testicular delineation—a new sign of pneumoperitoneum. Br J Radiol 55:867–868
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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
- Bone Marrow
- Abdominal Pain
- Nuclear Medicine
- Bone Marrow Transplantation