Case Reports in Medicine

The massive scrotal edema demonstrated by our patient is frequently encountered by the urologic surgeon. The cause of the disease is the lack of a fully functional insulin receptor, which has a profound effect during fetal development and thereafter. A Sharp border between intense erythematous scrotal skin and adjacent skin. His scrotal size made walking difficult and required specially tailored trousers. Massive scrotal edema may result from right heart failure, as a consequence of severe obstructive sleep apnea and obesity-hypoventilation syndrome. A diagnostic biopsy was taken that was unremarkable beside superficial telangiectasias.

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Infobox medical condition new Articles to be expanded from July All articles to be expanded Articles with empty sections from July All articles with empty sections Articles using small message boxes. Views Read Edit View history. This page was last edited on 5 February , at Followup at two months demonstrated marked improvement in mental status.

Subsequent outpatient follow-up visits documented additional improvement and continued weight loss. In this paper, we present a case of massive scrotal edema in which the diagnosis went unrecognized for an extended period of time due to the unusual nature in which it presented. However, tracheostomy has been shown to be a viable alternative in treating morbidly obese patients with combined OSA and OHS [ 1 , 6 , 9 ]. In fact, Guilleminault et al.

According to Won et al. Indeed, the success of tracheostomy in treatment of OSA was clearly demonstrated in the case presented here. The massive scrotal edema demonstrated by our patient is frequently encountered by the urologic surgeon.

This condition has been attributed to several different etiologies, including medical causes cardiac failure, renal disease, blood dyscrasias, and ascites , obstructive conditions abdominal neoplasms, inguinal hernias, and thrombosis of spermatic vein , infectious diseases filarial elephantiasis , iatrogenic interventions radiation therapy, node dissection , and trauma [ 12 , 13 ]. Important diagnostic clues for determining the etiology of scrotal edema include age of patient, acuteness of presentation, and presence of pain [ 14 ].

Because response to medical therapy is poor, surgical intervention is considered the best option for treatment of scrotal edema. Of the multiple operative procedures detailed, excisional therapy continues to remain the most prominent [ 15 ]. This method is both expeditious and has enjoyed successful, reproducible, long-term results [ 15 , 16 ]. Secondary coverage following dissection can be obtained from retained dorsal scrotal skin, split thickness skin grafting, or fasciocutaneous flaps from the thigh [ 15 ].

The case presented here is notable because it delivers two lessons. First, obstructive sleep apnea and obesity-hypoventilation syndrome may present with massive scrotal edema. This striking physical finding is the consequence of right heart failure thought to be due to pulmonary arterial hypoxemia and hypercapnia, which causes pulmonary arterial acidemia and vasoconstriction. The pulmonary hypertension resulting from these chemical stimuli leads to right heart failure [ 4 ].

Astute physicians and surgeons should recognize that scrotal edema occurring in patients with severe obstructive sleep apnea will likely be reversed upon the successful treatment of the sleep apnea.

Indeed, no operative intervention should be entertained, at least initially. We suggest that massive scrotal edema without obvious cause should prompt a physician or surgeon to ask whether the patient might be suffering from undiagnosed and untreated sleep apnea and obesity-hypoventilation syndrome.

Massive scrotal edema may result from right heart failure, as a consequence of severe obstructive sleep apnea and obesity-hypoventilation syndrome. In the patient presented here, tracheostomy to correct underlying obstructive sleep apnea produced improved oxygenation status, improved cardiac function, and a dramatic subsequent decrease in scrotal size.

Corrective scrotal surgery did not prove necessary. Otherwise unexplained massive scrotal edema in a morbidly obese patient might prompt suspicion of the presence of severe obstructive sleep apnea with right heart failure.

Case Reports in Medicine. Indexed in Web of Science. Subscribe to Table of Contents Alerts. Table of Contents Alerts. Abstract Obstructive sleep apnea OSA may occur in association with obesity-hypoventilation Pickwickian syndrome, a disorder of ventilatory control affecting individuals with morbid obesity. Background Obstructive sleep apnea OSA is a syndrome characterized most often by symptoms of loud snoring, breathing interruptions or awakenings during sleep, and excessive daytime sleepiness [ 1 ].

Our patient at admission. When standing, the scrotum descended to his knees and interfered with ambulation. The penis is no exception to the rule. However, many men may be too embarrassed to seek a proper medical doctor care when this happens.

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Remember that your healthcare provider treats penile infections and penis inflammations of all kinds on a daily basis. His or her job is to treat you, not to judge you. Any and all information, images and written material included on ErectileDysfunction. Content is not intended to diagnose or treat any medical ailments or problems, and in no case should it ever take the place of proper and immediate medical attention. Never substitute this website, or any other, for an appointment with your physician.

In penile inflammation, either the head of the genital or the entire penis can be affected.

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