Melissa Oye, D.O.
Resident Physician
University of Florida, Jacksonville, United States
Disclosure information not submitted.
Kevin Green, M.D.
Pulmonary and Critical Care Fellow
University of Florida, Jacksonville, United States
Disclosure information not submitted.
Nimeh Najjar, M.D.
Attending Physician
University of Florida - Jacksonville, United States
Disclosure information not submitted.
Title: Pneumoscrotum as a Complication of Spontaneous Pneumothorax in a COVID-19 Patient
Case Report Body:
Introduction: Pneumoscrotum is a condition characterized by air or gas accumulation within the scrotal sac. Prompt recognition is needed as this can be a late complication of a spontaneous pneumothorax.
Description: A 75-year-old male with COVID-19, presented for progressively worsening dyspnea. Chest imaging revealed a large left sided pneumothorax (PTX) and underwent chest tube placement. Initially, there was near resolution of the PTX; however, on hospital day 3 the patient developed subcutaneous emphysema. The air eventually involved the scrotum. Despite conservative management, the pneumoscrotum persisted. Subcutaneous angio-catheters were placed but were unsuccessful and the patient was intubated. One week after presentation, the patient succumbed to complications of COVID-19 before resolution of the pneumoscrotum was accomplished.
Discussion: Pneumoscrotum is an uncommon clinical manifestation that presents as scrotal swelling. The initial step is to determine the route of air entry. Etiology is usually from trauma or iatrogenic after cardiothoracic or gastrointestinal surgery. Rarely has it been reported as a complication from a spontaneous pneumothorax (PTX). Conservative management includes scrotal sling, adequate pain control, and placement of an indwelling Foley catheter. Doppler ultrasound can be used to assess for testicular blood flow. Urologic evaluation is often not needed. In this case, the pneumoscrotum was caused by an underlying PTX without any history of trauma or iatrogenic cause. There have been numerous case reports detailing spontaneous air leaks as a complication from COVID-19 infection. Despite chest tube placement for the treatment of the PTX, the pneumoscrotum persisted. The timeframe for resolution of the air leak in the setting of COVID-19 is unknown. Angio-catheters were placed along the thoracic and lateral abdominal walls. There was minimal decompression and ultimately the air re-accumulated within hours after placement. The patient eventually required intubation. There is no established treatment options if conservative management fails. Due to this patient’s untimely demise, it is unknown if the pneumoscrotum would have resolved with more time. As reported cases of COVID-19 related air leaks rise, practitioners should be vigilant for the late complication of pneumoscrotum.