Morel-Lavallee Lesion Initially Diagnosed as Quadriceps Contusion: Ultrasound, MRI, and Importance of Early Intervention

Abstract

Morel-Lavallee lesions (MLL) are rare, closed degloving injuries caused by trauma that delivers a shearing force to the soft tissue most commonly of the hip. If not treated in the acute and subacute setting these lesions are often complicated by re-accumulation of fluid, infection, or chronic pain. We present a unique case of a recurrent, massive medial knee/thigh MLL in which proper treatment was delayed due to initial diagnosis of a quadriceps contusion. We describe the ultrasound and magnetic resonance imaging findings of this patient and based on a review of recent literature propose that the initial management should have included early drainage/debridement, which likely could have prevented recurrence and significantly shortened the clinical course.

Unusual Morel-Lavallee lesion of the knee region in an elderly patient

“…In spite of the evidence in the history and clinical examination, the rarity of the diagnosis makes it an uncommon detection initially. This has been documented as a primary reason for the failure of early detection in the literature 7. The other reason these lesions are commonly missed is that these lesions can often be slow to progress and declare themselves, again making the diagnosis difficult in the initial stages 1…”

Morel‐Lavallee injury a case study

“…Over time, there is resorption of the hemorrhagic elements, increasing the serosanguinous fluid and progressive fibrous encapsulation which hinders resorption and leads to a slow continued expansion . The areas most likely to suffer from Morel‐Lavallee injuries are the hip/greater trochanter, anterolateral thigh, gluteal, lumbodorsal, and scapular regions . They are usually found adjacent to osseous protuberances…”

“…6,9 The areas most likely to suffer from Morel-Lavallee injuries are the hip/greater trochanter, anterolateral thigh, gluteal, lumbodorsal, and scapular regions. 4,10 They are usually found adjacent to osseous protuberances. 5 In 2005, Mellado and Bencardino proposed an extensive six-stage imaging-based classification based on the shape of lesion, signal intensity on T1-and T2-weighted images, presence of fibrous capsule, contrast enhancement, and sinus tract formation capsule 11…”

Management of Post-Traumatic Complications by Interventional Ultrasound: a Review

“…Diagnosis and treatment are frequently delayed, because the lesion usually develops several days after the trauma [65], increasing the risk of infection [66]. Incidence and the natural history of this lesion are unknown since only the case series is reported in the literature on this topic; although, patients are mainly female and with a BMI higher than 25 [64, 67•].…”