Pneumoscrotum is a rare condition that receives little discussion in standard texts of urology. The variety of possible etiologies for this condition include air accumulation from lung or retroperitoneal sources, surgical manipulations, or infection with gas-producing organisms. We report the case of a 79-year-old patient with pneumoscrotum who presented to the emergency department complaining of a swollen scrotum. Although Fournier's gangrene was suspected and the patient was taken to surgery, a small right apical pneumothorax that was not appreciated before surgery later was determined to have caused the pneumoscrotum. The process by which air may accumulate in the scrotum as well as differential diagnosis and treatment are discussed.