Musculoskeletal system
Case TypeClinical Cases
Authors
Pradeep Raj Regmi1, Kamal Kandel2, Saroj Poudel3, Prakash Banjade2
Patient30 years, female
The patient is a 30-year-old female who presented to the emergency department with a history of trauma that occurred 2 weeks ago. According to the patient, she was involved in a motor vehicle accident and suffered from multiple injuries, including cuts and bruises on her face and limbs. She was initially evaluated at a local hospital, where she received basic first aid and was advised to rest at home. However, she had difficulty in walking and visited our hospital.
Ultrasound shows well-defined collection between the subcutaneous fat and deep fascial plane (Figure 1). Imaging findings revealed Axial STIR high signal intensity collection between the subcutaneous fat and deep fascial plane (Figure 2), Figure 3 (sagittal T2) and Figure 4 (Sagittal STIR).
Background
A Morel-Lavallée lesion is a type of closed degloving injury that occurs when a shearing force separates the skin and subcutaneous tissue from the underlying muscle or bone [1]. This separation creates a potential space that can fill with fluid, blood, and other debris, resulting in a lesion typically located on the thigh or hip [1]. Morel-Lavallée lesions are commonly seen in athletes and patients who have been involved in motor vehicle accidents [2].
Clinical Perspective
Morel-Lavallée lesions typically present as a palpable mass, often associated with pain, swelling, and bruising in the affected area. The overlying skin may appear normal or discoloured, and there may be fluid or pus draining from the lesion [1]. The clinical problem with Morel-Lavallée lesions is that they can be mistaken for other lesions such as fat necrosis, haematoma, haemangioma, soft tissue sarcoma, early myositis ossificans, bursitis or infections, leading to delays in diagnosis and treatment [3]. Imaging studies, such as ultrasound or MRI, are often needed to confirm the diagnosis and determine the extent of the injury. These studies can also help guide treatment decisions, such as determining the optimal location for drainage of the fluid or debris from the lesion [2]. Early recognition and treatment are important in preventing complications, such as infection or chronic pain, and promoting optimal healing [3].
From imaging studies like MRI we need to confirm the presence of a fluid collection between the skin and subcutaneous tissue, consistent with a Morel-Lavallée lesion. Based on the imaging findings, we should recommend drainage of the fluid collection, with consideration for surgical debridement if there is evidence of tissue necrosis or infection.
Imaging Perspective
Imaging studies play a crucial role in the diagnosis of Morel-Lavallée lesions. Ultrasound is often the initial imaging modality, as it is non-invasive and readily available. Diagnostic pearls include the identification of a well-defined hypoechoic or anechoic fluid collection between the skin and subcutaneous tissue, with a thin echogenic rim corresponding to the capsule of the lesion [2]. Colour Doppler may be used to exclude the presence of vascular flow within the lesion, which would suggest an alternate diagnosis [3]. MRI is investigation of choice in the evaluation of Morel-Lavallée lesions, as it provides superior soft tissue contrast and can help delineate the extent of the lesion and any associated tissue damage [2]. Key findings on MRI include a fluid collection with a low signal intensity capsule on T1-weighted images and high signal intensity on T2-weighted images [2]. The final diagnosis of Morel-Lavallée lesion is typically made through a combination of clinical presentation, imaging studies, and aspiration of the fluid or debris from the lesion for analysis.
Outcome
The outcome of Morel-Lavallée lesions depends on the severity of the injury and the promptness of treatment [1]. Therapeutic options include conservative measures such as compression, immobilization, and drainage of the fluid or debris from the lesion, as well as more aggressive interventions such as surgical debridement or skin grafting in cases of tissue necrosis or infection [3]. The prognosis of Morel-Lavallée lesions is generally good with early recognition and appropriate treatment, but delayed or inadequate treatment can lead to complications such as chronic pain, scarring, and infection [3]. Imaging studies are essential in planning therapy, as they can help identify the extent and location of the lesion, guide the selection of appropriate drainage or surgical techniques, and monitor the response to treatment.
Take Home Message / Teaching Points
Morel-Lavallée lesion is a type of closed degloving injury that can present as a palpable mass with pain, swelling, and bruising, and can be mistaken for other soft tissue injuries or infections. Imaging studies, such as ultrasound or MRI, are essential for diagnosing and evaluating the extent of the injury, as well as for planning appropriate therapy. Early recognition and treatment are critical for preventing complications and promoting optimal healing. The prognosis is generally good with timely and appropriate intervention, but delayed or inadequate treatment can lead to chronic pain, scarring, and infection.
[1] Diviti S, Gupta N, Hooda K, Sharma K, Lo L (2017) Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management. J Clin Diagn Res 11(4):TE01. Available from: /pmc/articles/PMC5449878/
[2] Joseph U, Thangayah JR (2023) What lies beneath: A case report of Morel-Lavallée lesion. Proc Singap Healthc 32:20101058231152050
[3] Singh R, Rymer B, Youssef B, Lim J (2018) The Morel-Lavallée lesion and its management: A review of the literature. J Orthop 15(4):917–21
URL: | https://www.eurorad.org/case/18226 |
DOI: | 10.35100/eurorad/case.18226 |
ISSN: | 1563-4086 |
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