Case Report

212 Urology Journal    Vol 7    No 3    Summer 2010

Diffuse Aerodermectasia
Floating Body Sign

Michael Plaza,1 Justin La Plante2

Urol J. 2010;7:212-3.
www.uj.unrc.ir

Keywords: scrotum, subcutaneous 
emphysema, genital diseases

1Jackson Memorial Hospital, 
University of Miami, Miami, USA

2University of Utah Health Sciences 
Center, Salt Lake City, UT, USA

Corresponding Author:
Michael Plaza, MD

Jackson Memorial Hospital, 
University of Miami, 1611 NW  
12th Ave., West Wing No.279, 

Miami, FL 33136, USA
Tel: +1 704 779 5604

E-mail: mjplaza@yahoo.com

Received June 2009
Accepted October 2009

INTRODUCTION
Presence of subcutaneous air in 
the scrotum is a rare condition 
and only a few cases have been 
reported in the literature.(1) Air in 
the scrotum secondary to trauma is 
even far less common and minimal 
discussion exists on this topic. 
We present a case of traumatic 
pneumoscrotum which was made 
unique by the fact that the amount 
of air introduced into the scrotum 
was so extensive that was dissected 
through the fat planes superiorly 
to the level of the scalp resulting 
in pneumoretroperitoneum and 
pneumomediastinum along the 
way. We discuss the presentation, 
clinical course, and treatment 
strategy of the patient.

CASE REPORT
A 55-year-old man with 
the past medical history of 
schizophrenia was admitted for 
diffuse subcutaneous emphysema 
secondary to self-inflicted scrotal 
barotrauma. The patient inserted 
the tube into the scrotum and 
introduced air until he began to 
feel air tracking up to his neck 
from the suprapubic region. On 
physical examination, the patient 
had palpable crepitus of the 
abdomen, the chest, the neck, and 
the extremities. Genitourinary 
examination demonstrated 
approximately 2 inches of the tube 
inserted into the scrotum with 
no bleeding around the site of 

insertion and no significant scrotal 
swelling. In addition, the patient 
had a nut and bolt through and 
through the urethra just below the 
coronal sulcus.

Computed tomography scan 
revealed diffuse subcutaneous air 
that extended from the patient’s 
proximal legs to his scalp, as 
well as pneumomediastinum and 
pneumoretroperitoneum. Figure 1 
demonstrates the contiguous 

Figure 1. Sagittal computed tomography scan 
of the abdomen and the pelvis in the lung 
window settings demonstrates subcutaneous 
air seen extending the length of the body. 
Green arrow: pneumomediastinum; Red 
arrow: Subcutaneous emphysema



Pneumoscrotum—Plaza and La Plante

213Urology Journal    Vol 7    No 3    Summer 2010

nature of the subcutaneous air as it extends the 
length of the body in a circumferential way. 
Figure 2 demonstrates pneumomediastinum and 
represents the floating body sign, which refers to 
the radiographic appearance of subcutaneous air 
encircling the torso or any extremity.

The nut and bolt were removed without difficulty 
and the tube was removed from the scrotum. The 
patient had no difficulty or pain while urinating. 
The patient was observed overnight for possible 
respiratory compromise and was discharged the 
next day without intervention.

DISCUSSION
Our case illustrates the degree to which air 
may spread through out the soft tissues after 

initial introduction of air to the scrotum. For 
the development of diffuse aerodermectasia 
from an initial site of pneumoscrotum, a 
combination of two mechanisms of spread 
is suspected. Air passed through the inguinal 
canal and into the paranephric space, then 
superiorly into the mediastinum, resulting in 
the visualized pneumoretroperitoneum and 
pneumomediastinum. The second mechanism 
is that air from the scrotum traversed through 
Scarpa’s fascia to extend to the rest of the body’s 
subcutaneous soft tissues.(2)

The clinical presentation of traumatic 
pneumoscrotum is typically impressive to the 
treating physician; however, it is not emergent 
and care is supportive. The patient should 
be observed for more serious complications 
such as pneumothorax or air within the neck 
subcutaneous tissues expanding and leading to 
suffocation. The differential of pneumoscrotum 
includes iatrogenic procedures such as endoscopy, 
infection as in the case of Fournier’s gangrene, 
scrotal trauma, pneumothorax, and visceral 
perforation.(1-3)

CONFLICT OF INTEREST
None declared.

REFERENCES
1. Simaioforidis V, Kontos S, Fokitis I, Lefakis G, 

Koritsiadis S. Subcutaneous emphysema of 
the scrotum (pneumoscrotum) due to traumatic 
pneumothorax: a case report. Cases J. 2008;1:293.

2. watson HS, Klugo RC, Coffield KS. Pneumoscrotum: 
report of two cases and review of mechanisms of its 
development. Urology. 1992;40:517-21.

3. wakabayashi Y, Bush wH, Jr. Pneumoscrotum after 
blunt chest trauma. J Emerg Med. 1994;12:603-5.

Figure 2. Axial computed tomography scan at the level 
of the heart in the lung window settings demonstrates 
subcutaneous emphysema encircling the thorax and well as 
a significant degree of pneumomediastinum. Green arrow: 
pneumomediastinum; Red arrow: Subcutaneous emphysema