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

1903JH 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. [Clin Jour. 1903;23:71-80].

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
The onerous task of data review
JH Bryant Data review 1903

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. [J Emerg Med. 1987 Jul-Aug;5(4):323-9]

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)


Associated Persons


Alternative names

  • Bryant’s sign

References


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Dr Chloe Roy MBChB, BMed Sci (hons). Surgeon in the making | LinkedIn |

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