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

Objectives:To review the imaging characteristics of Morel-Lavallée lesions with both ultrasound and magnetic resonance imaging (MRI).Materials and Methods:We retrospectively analyzed 31 patients (mean age = 46 years), diagnosed with a Morel-Lavallée lesion, on ultrasound (n = 15) or MRI (n = 16). On ultrasound the echogenicity, internal septations, hyperechoic fat globules, compressibility and Doppler signal were evaluated. On MRI, T1- and T2-signal intensity, capsule presence, internal septations, enhancement, mass-effect and fluid-fluid levels were assessed. The MR images were classified according to the classification of Mellado and Bencardino.Results:Most of the lesions were situated peritrochanteric, around the knee or the lower leg. The majority of the lesions had a heterogeneous hypoechoic appearance with septations and intralesional fat globules. On MRI, most of the collections were hypointense on T1-weighted images and hyperintense on T2-weighted images. Half of the collections were encapsulated, and most collections demonstrated septations. The collections were classified as seroma (n = 10), subacute hematoma (n = 2) and chronic organizing hematoma (n = 5).Conclusion:Ultrasound is the imaging method of choice to diagnose Morel-Lavallée lesions. MRI can be of use in selected cases (extension in different compartments, large collections, superinfection). Characteristic imaging features include a fusiform fluid collection between the subcutaneous fat and the underlying fascia with internal septations and fat globules. On MRI, six types of ML lesion can be differentiated, with the seroma, the subacute hematoma, and the chronic organizing hematoma being the most frequently observed lesions.

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“…Management options include compression banding, aspiration, or incision and evacuation, with or without injection of sclerosing agents [229]. …”

Section: Discussionmentioning

confidence: 99%

Imaging Features of Morel-Lavallée Lesions

Coninck

Vanhoenacker²,

Verstraete

2017

Journal of the Belgian Society of Radiology

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“…We neither went for immediate fixation of the fracture nor operative debridement of the Morel-Lavallee lesion; instead waited for the soft tissues to heal after which surgical fixation was done. 13 In cases with concomitant urethral injury it is recommended to do internal fixation of the fracture before doing a suprapubic cystostomy wherever possible. However in developing countries, due to delay in referrals a suprapubic cystostomy becomes imperative before fixation can be done.…”

Section: Discussionmentioning

confidence: 99%

Acetabular fractures labelled poor surgical choices: Analysis of operative outcome

Gupta

Jindal

Pruthi³

2015

Journal of Clinical Orthopaedics and Trauma

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FracturesNeglected Osteoporosis a b s t r a c t Purpose: We report the surgical outcome in 52 patients with acetabular otherwise considered as poor surgical choices.Methods: 43 male and 9 female patients were operated at a mean age of 43 years and followed up for a mean duration of 60.3 months. There were 22 elementary fractures and 31 associated ones according to Letournal and Judet classification. Osteosynthesis was attempted in 48 patients whereas a primary total hip arthroplasty was performed in 4 patients. Outcome was assessed radiologically and functionally employing Harris Hip Score (HHS).Results: Average HHS in osteosynthesis group was 82.56 ± 12.4 with excellent to good results in 59.6% of the cases. Symptomatic osteoarthritis occurred in 13.5% of cases, avascular necrosis and severe heterotopic ossification in 7.7% each, infection and nerve palsy in 11.5% each. Conclusion:Although the complication rates in this series is marginally more than that reported in literature, we recommend that the indications of surgical fixation in acetabular fractures need to be extended to those which were considered poor surgical choices.

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“…Physical exam findings can include soft tissue swelling, contour deformity, bruising, skin hypermo-bility, hypoesthesia, or a palpable mass. 2 The gold standard for diagnosis is MRI, which shows various features depending on the chronicity of the lesion. In the acute setting, a hyperintense collection will appear on T2-weighted images, representing blood clots and debris.…”

Section: Discussionmentioning

confidence: 99%

Poor Outcome of Bilateral Lower Extremity Morel-Lavallee Lesions: A Case Report

et al. 2014

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The Morel-Lavallee lesion was first described in 1853 by the French physician, Maurice Morel-Lavallee. It is characterized by the separation of subcutaneous fat from the underlying fascia that is caused by a tangential, shearing force and often results in seroma or hematoma of the newly formed space. It is an uncommon sequela of posttraumatic closed degloving injury, often a pedestrian-motor vehicle collision, and is often underdiagnosed because the initial symptoms may consist of tenderness and ecchymosis, mimicking contusion. During the acute resuscitation phase of a polytrauma, this occult injury can be missed. Patients commonly present after the injury in the outpatient setting with complaints of a contour deformity or unresolving mass.We present the case of a woman who sustained bilateral Morel-Lavallee lesions of the lower extremities after being dragged by a bus. Case ReportA 77-year-old female with no significant past medical history presented to our Level I trauma center with tenderness and open wounds on both lower extremities after being caught in the doors of a bus and dragged for several hundred feet. She sustained a 5-cm wound on the left lateral ankle and a 3-cm wound on the lateral side of the dorsum of the left foot. There was significant edema bilaterally distal to the mid-lower extremities, over which the skin was paler and cooler; however, she was neurovascularly intact. She suffered bilateral fibular, bilateral medial malleolar, and multiple toe fractures bilaterally. She was admitted to the trauma service and underwent washout of her wounds and fixation of the fractures with orthopedic surgery. On hospital day 5, during fixation of the right lower extremity, skin necrosis was noted over both lower extremities. While awaiting further demarcation, skin necrosis developed on the left lower extremity as well. The patient required serial debridements managed by vacuum-assisted closure (VAC) dressings followed by splitthickness skin grafts. She was discharged to subacute rehabilitation on hospital day 52 in stable condition.The patient returned to the emergency room 38 days after discharge with open wounds of the split-thickness skin grafts. She had developed pressure ulcers on the grafts while at rehabilitation. The patient was admitted and underwent debridement of both legs. The extremities were debrided down to the bone, then packed and splinted with intent to offload the heels and prevent pressure ulcers. She underwent daily dressing changes and local wound care and was discharged to rehabilitation in stable condition. However, the Keywords ► Morel-Lavallee lesion ► internal degloving injury ► skin necrosis ► skin graft ► amputation ► trauma AbstractThe Morel-Lavallee lesion is a closed, internal degloving injury that results when a strong, shearing force is applied parallel to the plane of injury, as is common in vehicular trauma. It is an underdiagnosed entity that is often missed during the initial trauma workup as symptoms can be subtle. There are few reports of lesions occurring below th...

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

Cited by 48 publications

References 30 publications

Imaging Features of Morel-Lavallée Lesions

Imaging Features of Morel-Lavallée Lesions

Acetabular fractures labelled poor surgical choices: Analysis of operative outcome

Poor Outcome of Bilateral Lower Extremity Morel-Lavallee Lesions: A Case Report

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