pneumatocele

Pneumatocele is a lung bulla or rather an air filled cavity present within the lung parenchyma. It has various causes of origin. The bullous area is void of bronchoalveolar oxygenation and that certainly could result in dyspnea, hypoxia, symptomatic chest pain or even hemoptysis. This can result in spontaneous pneumothorax, pneumothorax provoked by mechanical ventilation or infection. We present a case of a 47yr old gentleman, who presented with a pneumatocele following trauma to chest. Prior to induction, thoracic epidural was inserted at T6-T7 and then he was intubated with the single lumen tube rather than the conventional double lumen tube for bullectomy. Post-operative pain relief using ropivacaine 0.375% and dexmedetomidine was effective. We discuss the anesthetic management and considerations in such a case.

Pneumoscrotum is the terminology used to describe the presence of air in the scrotal wall or within the tunica vaginalis. Etiology of pneumoscrotum is varied, ranging from idiopathic to Fournier’s gangrene or perforated bowel leading to significant morbidity and mortality. This paper reviews the existing literature on pneumoscrotum whilst documenting our experience with the same. Diagnosis is dependent on the patient’s anamnesis, clinical signs and imaging. We are presenting a case series of three such cases and a review of the existing literature on the same. The first case is a victim of a road traffic accident who subsequently presented with diffuse subcutaneous emphysema involving the scrotum. The second case is of Fournier’s gangrene with pneumoscrotum. The third case presented with a spontaneous isolated pneumoscrotum without any cause. Imaging such as Contrast-Enhanced CT and USG may be done to help narrow the differentials.