Blue Scrotum Sign of Bryant

Description

Bryant sign: Scrotal ecchymosis associated with ruptured abdominal aortic aneurysm (AAA). Extravasation of blood in the retroperitoneum may lead to non-traumatic discolouration beneath intact penile or scrotal epithelium. Ecchymosis typically appears within three to six days after AAA rupture

In order to be observed: blood must transverse the inguinal canal and spermatic cord down to the subcutaneous scrotal tissue. It requires a closed (retroperitoneal haematoma) or sealed (surrounding retroperitoneal and aortic tissue) rupture; slow rate of leakage and a prolonged interval prior to final rupture.

History of the Blue Scrotum Sign of Bryant

1903 – JH Bryant described scrotal ecchymosis associated with ruptured AAA during two lectures in which he had evaluated 18,678 necropsies and the 325 deaths secondary to abdominal aortic aneurysm rupture.

In these two articles Bryant correctly describes the diffuse nature of the atheromatous changes, the possible clinical presentation of AAA as apparent renal colic, and the scrotal and abdominal discolourations as diagnostic clues.

In one case blood was effused into the right spermatic cord, and the corresponding half of the scrotum was much ecchymosed…When blood is extravasated into the anterior abdominal wall ecchymoses may appear…‘

Bryant JH. Clin Jour. 1903;23:79

JH Bryant original description

Most recorded cases of Bryant’s sign occur three to six days after onset of abdominal symptoms as noted by Pearlman (1940), Barratt-Boyes (1957) and Beebe (1958)

1987 – RM Ratzan et al, identified the correct historical attribution of lower abdominal/scrotal discolouration secondary to aortic aneurysmal disease as belonging to John Henry Bryant.

Associated Persons

• John Henry Bryant and Bryant sign (1903)
• Thomas Stephen Cullen and Cullen sign (1918)
• George Grey Turner and Grey Turner sign (1919)
• Francis Edward Stabler and Stabler Sign (1934)
• John Adrian Fox and Fox sign (1966)

Alternative names

• Bryant’s sign

References

Historical articles

• Bryant JH. Two clinical lectures on aneurysm of the abdominal aorta: lecture 1. Clin Jour. 1903;23:71-80.

Reference articles

• Pearlman SJ. Ruptured aortic aneurysm, simulating renal tumor. Am J Surg. 1940;49:518–522
• Barratt-Boyes BG. Symptomatology and prognosis of abdominal aortic aneurysm. Lancet 1957; 270(6998): 716–720
• Beebe RT, Powers, SR, Jr, Ginouves E. The early diagnosis of ruptured abdominal aneurysm. Ann Intern Med. 1958; 48(4): 834-838
• Ratzan RM, Donaldson MC, Foster JH, Walzak MP. The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm. J Emerg Med. 1987; 5(4): 323-329
• Epperla N, Mazza JJ, Yale SH. A Review of Clinical Signs Related to Ecchymosis. WMJ. 2015; 114(2): 61-65
• Cadogan M. Atraumatic Abdominal Ecchymosis. LITFL 2020
• Davis AL, Shepherd T, Cadogan M, Foo J. Bryant’s sign as a manifestation of a retroperitoneal paraduodenal bleed and subsequent small bowel obstruction. BMJ Case Rep 2022;15:e247442.

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |