Post-Traumatic Cysts of Soft Tissue

Sterling, Anthony P.; Butterfield, William C.; Bonner, R. D.; Quigley, William F.; Marjani, Massoud A.

doi:10.1097/00005373-197705000-00012

Cited by 32 publications

(15 citation statements)

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“…6 Delay in the diagnosis results in the development of collections with bulging and deformity of the subcutaneous cellular tissue. 8 Missed diagnosis can lead to delayed presentation as a contour deformity due to local tissue necrosis .Morel-Lavallee lesions though uncommon are often missed injuries especially in polytraumatised patients seen at the emergency services in the presence of other severe injuries. 9 In cases of delayed diagnosis, an insidious progression of fluid accumulation resulted in progressive swelling, ecchymosis and thigh tightness with knee flexion, prompting the player to seek evaluation.…”

Section: Discussionmentioning

confidence: 99%

Morel-Lavallee lesion in distal thigh: A case report

Kumar¹,

Kumar²

2014

Journal of Clinical Orthopaedics and Trauma

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Close degloving injury Distal thigh ACL a b s t r a c tIt is a relatively rare condition involving a close degloving injury due to direct trauma with tangential force followed by the separation of the subcutaneous tissue from the underlying fascia. The rupture of small perforating vessels in this area, resulting in the formation of a cavity that filled with blood, lymph and fat foci, the latter being sometimes necrotic. MorelLavallee lesion was originally described in the lateral aspect of the proximal thigh, which is the most common site of this lesion; however other anatomic sites such as periscapular, lumbar and gluteal regions, ankles and knees have been described in the literature. Various methods of treatment has been described, but open debridement can result in a successful functional outcome.Copyright © 2014, Delhi Orthopaedic Association. All rights reserved. IntroductionMorel-Lavallee lesion is a common but rarely described posttraumatic closed soft tissue injury sequel. 1 MLL in distal thigh is a relatively rare condition involving a close degloving injury due to direct trauma with tangential force followed by the separation of the subcutaneous tissue from the underlying fascia. Because of it, the rupture of small perforating vessels in this area, resulting in the formation of a cavity filled with blood, lymph and fat foci, the latter being sometimes necrotic. 2,3 Morel-Lavallee lesion was originally described in the lateral aspect of the proximal thigh, which is the most common site of this lesion; however other anatomic sites such as periscapular, lumbar and gluteal regions, ankles and knees have been described in the literature. 4,5 The case is reported to us with swelling over the anteromedial aspect of distal left thigh with ipsilateral united fracture of medial tibial condyle and partial ACL tear. This type of combination of injuries has not been described previously. Surgical intervention in the form of open debridement was done and resulting in the dramatic improvement. Case reportA 45 years old male presented with swelling over anteromedial aspect of distal left thigh (Fig. 1A þ B). He complained pain left knee during walking and also, weakness left lower limb following trauma. He met with an accident one and half year back, while driving a motorcycle and he was hit by a car from back. He sustained fracture left clavicle, ipsilateral medial tibial condyle and bruises over the anterior aspect of left distal thigh managed conservatively. On follow-up of after one month POP slab was removed and found huge swelling

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Section: Discussionmentioning

confidence: 99%

Morel-Lavallee lesion in distal thigh: A case report

Kumar¹,

Kumar²

2014

Journal of Clinical Orthopaedics and Trauma

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“…Various theories have been postulated to explain the pathogenesis of postoperative seromas. These include persistent lymphatic leakage following surgery [19], crushing and shearing strains which may contribute to fluid collections at the junction of the subcutaneous fat [20], and reduced gravitational effect on the lymphatic and vascular drainage in the upper limb [16]. There are other likely contributory factors such as the fact that soft tissue tumours are commoner in the lower limb and tend to present later so that surgery is both more frequent and more extensive at this site.…”

Section: Discussionmentioning

confidence: 99%

The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

et al. 2004

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Fluid collections (seromas) may accumulate at the site of surgery following excision of musculoskeletal soft tissue tumours. The aim of this retrospective study was to review the magnetic resonance (MR) imaging features of postoperative seromas identifying changes over time on follow-up scans. A total of 170 MR scans from 80 patients were reviewed showing one or more seromas. All patients had undergone previous surgery for a musculoskeletal soft tissue tumour. The typical MR appearances of a seroma were shown to be a well-defined oval or rounded (54%) soft tissue mass, arising at the site of previous surgery, with a thin, dark pseudocapsule, surrounding soft tissue oedema (80%), homogeneous contents that are hypointense (relative to adjacent muscle) on T1-weighted images (74%) and hyperintense on T2-weighted and STIR images (79%). Approximately one-quarter of cases revealed atypical features including hyperintense contents on T1-weighted (26%) and/or heterogeneous contents on T2-weighted images (21%), reflecting the breakdown of blood products and organization of the fluid collection. A distinctive fine feathery pattern arising from the inner surface of the seroma or from septations was identified in 10% of cases. In those patients who underwent one or more follow-up scans, the volume of the seromas decreased in 66% cases, remained unchanged in 15% and increased in 19%. Seromas are not an uncommon finding (<10% of cases) following surgery for a soft tissue tumour. The majority of cases show the typical MR features of a fluid collection. The pitfalls in differentiating an atypical seroma from a recurrent soft tissue sarcoma are discussed.

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“…In general, patients with MLL present with a soft tissue swelling, contour deformity, bruising, skin hypermobility, decreased cutaneous sensations, or a palpable bulge. This lesion is generally misdiagnosed or diagnosed late when the swelling is missed in initial presentation or mistaken for local edema [9]. Diagnostic delay of up to 34 years has been described [6,17].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…In the literature, it has been described under various names, such as posttraumatic soft tissue cyst [9], pseudocyst [10], pseudolipoma [11], Morel Lavallee (ML) extravasation [10], Morel-Lavallee effusion [12], and Morel-Lavallee hematoma [13].…”

Section: Introductionmentioning

confidence: 99%

The Morel-Lavallee lesion: a review and a proposed algorithmic approach

et al. 2012

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Morel-Lavallee lesions (MLL) are rarely diagnosed posttraumatic sequel. They follow closed degloving injuries due to accumulation of blood and debris in the subcutaneous plane. Though they are not uncommon, they are rarely diagnosed which results in delay in their treatment. Diagnosis is through a combination of clinical examination, history, and imaging studies. MRI is the diagnostic modality of choice. Different treatments have been used for their management like compression therapy, sclerosant injection, pulse lavage, and open debridement. These treatments have met with varying success. Treatment protocols vary when managing acute and chronic MLL. The knowledge of such lesions hastens their diagnosis and treatment.

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Post-Traumatic Cysts of Soft Tissue

Cited by 32 publications

References 0 publications

Morel-Lavallee lesion in distal thigh: A case report

Morel-Lavallee lesion in distal thigh: A case report

The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

The Morel-Lavallee lesion: a review and a proposed algorithmic approach

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