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Humayun A, Chai LF, Pontell ME, Jankowski MA. Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma. Int J Crit Illn Inj Sci 2019; 8:210-213. [PMID: 30662868 PMCID: PMC6311965 DOI: 10.4103/ijciis.ijciis_52_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Ammar Humayun
- Department of Trauma and Acute Care Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Louis F Chai
- Department of Trauma and Acute Care Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Matthew E Pontell
- Department of Trauma and Acute Care Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Marcin A Jankowski
- Department of Trauma and Acute Care Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA 19102, USA
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Cochetti G, Barillaro F, Cottini E, D'Amico F, Pansadoro A, Pohja S, Boni A, Cirocchi R, Grassi V, Mancuso R, Silvi E, Ioannidou K, Egidi MG, Poli G, Mearini E. Pneumoscrotum: report of two different cases and review of the literature. Ther Clin Risk Manag 2015; 11:581-7. [PMID: 25914539 PMCID: PMC4399391 DOI: 10.2147/tcrm.s77326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Francesco Barillaro
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Emanuele Cottini
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Francesco D'Amico
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Alberto Pansadoro
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Solajd Pohja
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - Veronica Grassi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - Rosa Mancuso
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Elisa Silvi
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Katifenia Ioannidou
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Maria Giulia Egidi
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Giulia Poli
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy
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Peiris D, Wirtanen C, Hall J. Aeromedical evacuations from an east Arnhem Land community 2003?2005: The impact on a primary health care centre. Aust J Rural Health 2006; 14:270-4. [PMID: 17121507 DOI: 10.1111/j.1440-1584.2006.00828.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To understand the profile and impact of aeromedical evacuations in remote Indigenous communities. DESIGN Descriptive study. SETTING A primary health care centre in east Arnhem Land, Northern Territory, Australia. PARTICIPANTS Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005. MAIN OUTCOME MEASURES Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources. RESULTS On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours. CONCLUSION Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs.
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Affiliation(s)
- David Peiris
- Ngalkanbuy Health Centre, Galiwin'ku, Elcho Island, Northern Territory, Australia.
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