A 72 year old man from Ohio showed up one day in the emergency room complaining of a swollen face, shortness of breath, and something very peculiar: a hissing scrotum. Or put another way: that his testicles rang. Yes, oddly enough, the wrap that covers his testicles was leaking air to the point of generating a little hiss. Logically, for the patient it was something very strange, but the toilets did not take long to diagnose what was happening to him as a pneumoscrotum.
It is not a particularly common pathology, but it is true that there are quite a few cases described in the scientific literature. However, it is usually just the accumulation of air, not necessarily from its sibilant release. It is usually due to trauma to the testicular area, although in his case he did not remember having had any. But yes, he had undergone an operation to treat a epididymitis. That is, an inflammation of the tube that joins the testicles and the vas deferens, which in turn will lead to the ejaculatory tubes.
According to the scientists who treated him in a study published in American Journal of Case Reportsin said intervention an incision was made in the scrotum and drainage. Everything went well, apparently, but soon after he found himself in the hospital with a wheezing pneumoscrotumas well as other pathologies derived from the accumulation of air in the chest.
Much more than a hissing scrotum
Tests performed on the patient showed much more than the hissing scrotum. She also had a Bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema. The first consists of the accumulation of air in a cavity between the lungs and the chest known as the pleural cavity. The second is also due to an accumulation of air, this time in a cavity located between the two lungs. And, finally, subcutaneous emphysema consists of the penetration of air into the tissues located under the skin.
It is not uncommon for a pneumoscrotum to be accompanied by problems with the accumulation of air in the rib cage. For example, in 2011 a case was described of a man who developed one after a tracheostomy. After the intervention, he was diagnosed with subcutaneous emphysema and this ended up causing pneumoscrotum. Therefore, generally the air leak ends up causing it to accumulate around the testicles. But in the case of this patient, precisely because he had a previous incision, the air it came out little by little instead of accumulating.
Now, was this positive? It is not known, as explained by the study authors. “You will never know if the air leak attenuated the patient’s presentation and led to a more favorable outcome.”
Fortunately, it was treated.
The patient was treated with tubes with which excess air has been drained from the chest. This also relieved the pain in the scrotum. Nevertheless, had to undergo another intervention to return it to normal. And the worst thing is that in the future it could end up requiring the removal of the testicles. Although everything will depend on its evolution.
At the moment, the most serious has passed and he has been discharged. However, he will most likely never forget how what seemed like a very simple intervention ended up giving rise to one of those medical cases that happen to very few people in history.