[Pneumoscrotum as a consequence of long-term ventilation]

Area of Science:

• Critical Care Medicine
• Pulmonology
• Radiology

Background:

• Long-term mechanical ventilation is a cornerstone of intensive care for patients with severe respiratory failure.
• Complications of mechanical ventilation can include barotrauma and air leak syndromes.
• Pneumoscrotum is an exceptionally rare complication, particularly in the context of extensive emphysema.

Observation:

• A 59-year-old male patient with adult respiratory distress syndrome (ARDS) on prolonged mechanical ventilation developed severe subcutaneous emphysema.
• Clinical examination and computed tomography (CT) revealed widespread emphysema affecting the neck, chest, abdomen, mediastinum, and retroperitoneum.
• The patient also presented with pneumoperitoneum, pneumoperineum, and a confirmed pneumoscrotum.

Findings:

• Computed tomography (CT) imaging is crucial for diagnosing the extent of air dissection in pneumoscrotum and associated emphysema.
• Scrotal puncture confirmed the presence of air within the scrotum, establishing the diagnosis of pneumoscrotum.
• The extensive air leak syndrome contributed to the patient's critical condition.

Implications:

• This case underscores the importance of recognizing pneumoscrotum as a rare but possible complication of prolonged mechanical ventilation.
• Awareness of such rare entities is vital for intensive care physicians managing complex ventilated patients.
• Further investigation into the mechanisms and management of ventilator-induced pneumoscrotum may be warranted.