Pneumoscrotum, a Rare Presentation of Barotrauma Following Noninvasive Positive Pressure Ventilation in Patients with Severe COVID-19 Pneumonia

Authors

  • Behnam Dalfardi Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
  • Mohsen Shafiepour Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
  • Seyed Mehdi Hashemi Bajgani Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
  • Mohammad Javad Najafzadeh Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran

DOI:

https://doi.org/10.31661/gmj.v11i.2372

Keywords:

Barotrauma, COVID-19, Noninvasive Ventilation, Pneumoscrotum

Abstract

Background: Patients with Coronavirus disease 2019 (COVID-19) pneumonia are at risk of hypoxemic respiratory failure. Hence, many patients may require noninvasive positive pressure ventilation (NIPPV) during their hospital course. Using mechanical ventilation such as bilevel positive airway pressure or a ventilator to provide NIPPV may result in adverse events, including barotrauma. Case Report: We reported two cases (40- and 43-years-old men) of severe COVID-19 pneumonia and hypoxemic respiratory failure who underwent NIPPV for respiratory support. These cases were complicated with barotrauma in their course of hospital admission that manifested with pneumoscrotum. Conclusion: In the cases of pneumoscrotum, it is crucial to understand its underlying etiology and origin since this clinical finding may be the outcome of life-threatening illnesses requiring urgent treatment.

References

Hamouri S, Samrah SM, Albawaih O, Saleh Z, Smadi MM, et al. Pulmonary barotrauma in COVID-19 patients: Invasive versus noninvasive positive pressure ventilation. Int J Gen Med. 2021;14:2017-32. https://doi.org/10.2147/IJGM.S314155PMid:34079341 PMCid:PMC8164351 Faraone A, Beltrame C, Crociani A, Carrai P, Lovicu E, et al. Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID-19-associated acute hypoxemic respiratory failure: a single center, non-ICU setting experience. Intern Emerg Med. 2021;16(5):1183-90. https://doi.org/10.1007/s11739-020-02562-2PMid:33222116 PMCid:PMC7680552 Dobler CC, Murad MH, Wilson ME. Noninvasive positive pressure ventilation in patients with COVID-19. Mayo Clin Proc. 2020;95(12):2594-601. https://doi.org/10.1016/j.mayocp.2020.10.001PMid:33276832 PMCid:PMC7543969 Bonny R, Moh EN, Aké YL, Kouassi AS, Midékor K, et al. Extensive pneumoscrotum and pneumoperitoneum simulating a compound inguino scrotal hernia in a neonate. Journal of Pediatric Surgery Case Reports. 2017;18:16-8. https://doi.org/10.1016/j.epsc.2017.01.007 Noujeim JP, Ibrahim S, Noujeim A, Haddad Y. Pneumoscrotum caused by a bronchopleural fistula. Cureus. 2021;13(8):e17270. https://doi.org/10.7759/cureus.17270PMid:34540491 PMCid:PMC8448265 Akbulut S, Isik B, Karipkiz Y, Yilmaz S. Massive subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum following endoscopic retrograde cholangiopancreatography in a living liver donor. Int J Organ Transplant Med. 2018;9(3):132-5. https://doi.org/10.26226/morressier.58eb975ed462b80290b4fe45 Khan MS, Jamal F, Khan Z, Tiwari A, Simo H, et al. ERCP-related duodenal perforation presenting as pneumoscrotum. Case Rep Gastroenterology. 2018;12(1):1-6. https://doi.org/10.1159/000485557PMid:29515338 PMCid:PMC5836279 Edey S, Whitaker J, Vivekanandan S. Pneumoscrotum following computed tomography pneumocolon. BMJ. 2017;357. https://doi.org/10.1136/bmj.j1825 Sunderland MS, Dakwar A, Rishi A, Bennett RD. Pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum following transanal excision of rectal polyp. Am Surg. 2020:3134820956359. https://doi.org/10.1177/0003134820956359PMid:33342273 Humayun A, Chai LF, Pontell ME, Jankowski MA. Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma. Int J Crit Illn Inj Sci. 2018;8(4):210-3. https://doi.org/10.4103/IJCIIS.IJCIIS_52_18PMid:30662868 PMCid:PMC6311965 Jandou I, Moataz DA, Adnan Ettanji, Dakir Mohammed, Adil Debbagh, et al. Pneumoscrotum: A rare complication of ruptured emphysema bullae. Urol Case Rep. 2021;34:101476. https://doi.org/10.1016/j.eucr.2020.101476PMid:33204641 PMCid:PMC7649614 Firmanto R, Widia F, Irdam GA. Pneumoscrotum in patient with pneumothorax: A case report. Urol Case Rep. 2019;27:100915. https://doi.org/10.1016/j.eucr.2019.100915PMid:31687351 PMCid:PMC6819812

Published

2022-11-20

Issue

Section

Case Report/Series