PMC5836279_01
Clinical photograph showing diffuse scrotal swelling.
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F1
On examination, his scrotum was diffusely enlarged 3-4 times the normal size; no skin erythema or necrosis was noted (Fig. 1).
A Plain radiograph of the pelvis showing an enlarged scrotal shadow with presence of air in it. B Sagittal sonographic image of the scrotum showing a reflection of the ultrasound beam suggesting air inside the scrotum.
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F2
Scrotal ultrasound was done, which did not show any fluid collection; however, it showed presence of air in the scrotal sac with reflection of ultrasound waves limiting further evaluation (Fig. 2B). An abdominal radiograph showed enlarged scrotal soft tissue shadow with presence of air in the fascial planes concerning for subcutaneous emphysema (Fig. 2A).
A Axial CT image of the chest showing pneumomediastinum along with subcutaneous emphysema involving the chest wall on the left side. B Axial CT of the abdomen showing pneumoretroperitoneum surrounding the right kidney along with subcutaneous emphysema.
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F3
CT of the abdomen and pelvis showed extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum along with subcutaneous emphysema involving the soft tissue of abdomen and perineum (Fig. 3 and 4).
A, B Axial CT images at the level of the pelvis showing enlargement of the scrotal sac with presence of air inside it consistent with pneumoscrotum. Extensive subcutaneous emphysema involving the perineum and the penile region can be visualized.
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F4
CT of the abdomen and pelvis showed extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum along with subcutaneous emphysema involving the soft tissue of abdomen and perineum (Fig. 3 and 4).