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Man Comes To Hospital With Mysterious Case Of "Whistling Scrotum", And – Wait, What?

The tests have come back, and we're afraid it's an A flat.

author

Dr. Katie Spalding

Freelance Writer

clockJul 1 2022, 16:06 UTC
Hands playing a flute
I'm allowed to make this joke, I've mastered both fingering and double-tonguing. Image credit: Zhuravlev Andrey/Shutterstock.com

The human body makes all kinds of funny noises. It’s alright, we’re grownups, we can admit it. There are farts, burps, grumbles, sneezes, snorts, squelches, and even squirts, all emanating from various bits of these soggy sacks of meat and bones that carry us through our lives.

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But sometimes those noises can be a sign of something going wrong. Even the more benign ones, like a cheerful whistle, would be unwelcome if they came from the wrong place. Say … a scrotum.

“A 72-year-old man who recently underwent a scrotal incision and drainage for recurrent epididymitis presented to a local emergency room with chief concerns of ‘whistling scrotum’ and dyspnea [shortness of breath],” reads a paper published last month in the American Journal of Case Reports

“This case report describes … a patient with an open scrotal wound from a recent scrotal procedure, which allowed the air to escape from his abdominal compartment, and resulted in his ‘scrotal whistling’,” the authors write in what is possibly the worst collection of words we’ve seen since all those people ate vulture puke in Kentucky that one time

And how does one end up with a whistling scrotum, you ask? Well, in this case, it was a “unique presentation of a common entity … within pulmonology/critical care,” explain the authors: it was a consequence of a collapsed lung, or pneumothorax. 

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Now, a “collapsed lung” is a bit of a misnomer, due to lungs working the exact opposite way from how you’d expect. A collapsed lung hasn’t really “collapsed” so much as “been made to collapse” – it’s the result of an influx of air into the space between the lungs and the chest wall.

Under normal circumstances, what happens next is that a patient will suffer severe chest pain, struggle to breathe, and maybe even turn blue. But as we’ve seen, these weren’t normal circumstances.

“[A] chest CT revealed bilateral pneumothoraces, pneumomediastinum, and excessive subcutaneous emphysema throughout his abdomen, perineum, and scrotum,” notes the case report. “His scrotum had a dehiscent wound without any gross edema or air trapping contained within the scrotum.”

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Stripped of medical jargon, this translates to “the guy was full of air.” For some reason – and the doctors say it’s “unclear” how exactly it happened – that air surrounding the collapsed lung had apparently spread out, into the space between his lungs, the space around his other lung, and throughout the tissues beneath the patient’s skin in his abdomen and groin areas.

And this is where the patient’s history comes into play. Remember how he had an “open scrotal wound” from a previous surgery? That had been to treat a testicular infection – but with a belly full of air, it turned into something altogether more audible. Like the humble bagpipe, the patient’s condition had resulted in air being forced out of his abdomen, through the hole in his balls, and creating a noise that makes you want to go to the hospital.

The good news is the patient recovered: the doctors put in bilateral chest tubes and subcutaneous air drains to release the air around his lungs and inside the tissues under his skin. The air in his groin and thighs hung around a little longer, and the patient needed a second scrotal surgery, but eventually, that too cleared up.

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And if the patient had a bad time of it, at least he can take heart in knowing that he’s a world-first in the medical world. 

“Pneumoscrotum [air accumulating in the scrotum] is a rare clinical occurrence,” the authors write. “The origin of air is primarily from trauma, but spontaneous pneumoscrotum can develop from gastrointestinal or pulmonary sources.”

“However, pneumoscrotum in the setting of a scrotal wound, which allows air to pass freely outside the body, has not been previously documented in the literature.”


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