Whistling Scrotum: An Unusual Presentation

"A 72-year-old man presented to a local emergency room with chief concerns of 'whistling scrotum' ... " | PLUS: How to treat Red Scrotum


Pneumoscrotum is a rare clinical occurrence in which air accumulates in the scrotum.

The origin of air is primarily from trauma, but spontaneous pneumoscrotum can develop from gastrointestinal or pulmonary sources.

Physical examination of pneumoscrotum typically includes crepitus of the perineal region and scrotal swelling and associated findings depending on the origin of the free air. 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.

“This case report describes a unique presentation which allowed the air to escape from his abdominal compartment, and resulted in his ‘scrotal whistling.'”


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.

The chest CT revealed bilateral pneumothoraces, pneumomediastinum, and excessive subcutaneous emphysema throughout his abdomen, perineum, and scrotum. His scrotum had a dehiscent wound without any gross edema or air trapping contained within the scrotum.

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He received bilateral chest tubes and subcutaneous air drains with complete resolution of his pneumothoraces. The pneumoscrotum and associated subcutaneous emphysema of the perineum and thighs resolved after a prolonged period, and necessitated additional scrotal surgery.


Prompt evaluation for source control is necessary with pneumoscrotum, as the source likely requires immediate stabilization or surgical intervention. This case report describes a unique presentation of a common entity (pneumothorax) within pulmonology/critical care in 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.”

It is unclear how the air passing through the scrotum affected the patient’s presentation, such as allowing more air to build up in the subcutaneous tissues versus developing critical illness.

Brant Bickford, Andrew J. Berglund, Ronald J. Markert, Hari Polenakovik | DOI: 10.12659/AJCR.936441 | Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).

How to treat Red Scrotum

BUOY HEALTH – Red testicles can have associated symptoms of pain, itchiness, swelling, or dryness of the skin. Common causes for scrotal redness include allergic reactions to hygienic products, chemicals, or medication. In addition, skin conditions like eczema and scabies can cause a red scrotum.

Scrotal redness symptoms

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Issues related to the genital area can be embarrassing and uncomfortable situations to discuss; however, genital health is an important topic as it can signal underlying health problems beyond those related to reproductive or sexual capabilities such as ejaculation or erection. Any issues related to the penis or parts of the genitalia should be followed-up appropriately.

The scrotum is an external sac of skin that encloses the testicles (also known as testes). The testicles are the round, egg-shaped male reproductive organs behind the penis. The main function of the testes-scrotal system is the production of sperm male reproductive cells and testosterone, a hormone important for male sexual and reproductive development.

Common accompanying symptoms of scrotal redness

Scrotal redness may also be associated with symptoms such as:

  • Pain
  • Soreness or burning
  • Itching
  • Swelling
  • Warmth to the touch
  • Pain with urination (dysuria)
  • Penile discharge
  • Foul odor
  • Dry skin or scaling

Fortunately, scrotal redness is a benign and easily treatable disease. If you notice any of the symptoms above, follow-up promptly with your physician in order to get appropriate care and treatment.

Scrotal redness treatments and relief

Treatment for scrotal redness will depend on the cause and may include the following:

  • Antibiotics: Your physician will prescribe the appropriate antibiotics if your scrotal redness is the result of a bacterial infection such as chlamydia or gonorrhea.
  • Antifungal medication: Yeast such as candida are fungi that can be treated with topical or systemic medications that your healthcare provider can prescribe.
  • Dermatological creams: If your symptoms are caused by a dermatologic skin condition, your physician may prescribe steroid creams or ointments that can help alleviate your symptoms. However, it is important to remember that sometimes prolonged use of such creams can result in red scrotum syndrome as a side effect.
  • Anticonvulsant: Several anticonvulsant medications are used to combat nerve pain or burning. Some studies have shown improvement in conditions such as red scrotum syndrome with treatment with gabapentin … READ MORE. 


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