Risk Factors for Scrotal Emphysema
Scrotal emphysema is predominantly iatrogenic and posttraumatic in origin, with the primary risk factors being recent surgical procedures in the inguinal or retroperitoneal areas, chest trauma with pneumothorax, and penetrating scrotal injuries. 1, 2
Iatrogenic and Surgical Risk Factors
- Inguinal or retroperitoneal surgery is the most common risk factor, as air can track along tissue planes into the scrotum following these procedures 1
- Chest tube placement for pneumothorax creates a pathway for air dissection down through the mediastinum and retroperitoneum into the scrotal space 2
- Endotracheal intubation and mechanical ventilation, particularly in trauma patients with pneumothorax, can lead to air tracking into the scrotum 2
Traumatic Risk Factors
- Blunt scrotal trauma from athletic accidents or motor vehicle collisions can introduce air into scrotal tissues, though this is less common than hematoma or testicular rupture 3
- Penetrating trauma from gunshot wounds or other assault mechanisms can directly introduce air into the scrotum 3
- Degloving injuries resulting in scrotal skin avulsion may allow air entry 3
Thoracic and Respiratory Risk Factors
- Pneumothorax (traumatic or spontaneous) allows air to dissect along fascial planes from the chest through the mediastinum and retroperitoneum into the scrotum 1, 2
- Cardiopulmonary resuscitation with positive pressure ventilation can force air through tissue planes, particularly in patients with underlying respiratory compromise 4
- Barotrauma from mechanical ventilation in critically ill patients creates pressure gradients that drive air dissection 4
Life-Threatening Associated Conditions
- Fournier's gangrene produces gas in scrotal tissues from necrotizing infection and must be immediately excluded through clinical assessment for crepitus, skin necrosis, or systemic toxicity 5, 4
- The presence of gas-forming organisms in Fournier's gangrene represents a surgical emergency requiring radical debridement 4
Rare and Miscellaneous Risk Factors
- Intentional self-inflation with needles or syringes has been reported, though this is uncommon 1
- Electrical burn injuries to the scrotum can create tissue disruption allowing air entry 3
Critical Clinical Pitfall
The key clinical imperative is to rapidly determine whether pneumoscrotum represents benign air tracking from a known source versus a life-threatening condition like Fournier's gangrene or tension pneumothorax. 2, 6 Look specifically for fever, tachycardia, hypotension, skin necrosis, crepitus extending beyond expected surgical sites, and elevated inflammatory markers (WBC, lactate, CRP) that would indicate necrotizing infection requiring emergency surgical intervention 5, 4