We report a rare case of a large mll that was successfully treated with compression. We have observed that the mll also occurs in the knee as a result of shearing trauma during football, and is a distinct lesion. Most of the patients sustained the lesion over the thigh followed by trochanteric region, lower back, and abdominal wall. Similar to ultrasonographic imaging, fat and debris may be visualized as well as fluidfluid levels. It most frequently occurs in the peritrochanteric region along the proximal lateral thigh, such as in this ct scan.
Sonography can be effectively used to diagnose and characterize soft tissue fluid collections. Morellavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863 1. Morellavallee lesions are a relatively rare clinical problem, referring to. Review open access morellavallee lesion in children. It was first described in 1848 by victoraugustefrancois morellavallee 18111865, a french surgeon 4. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Morellavallee lesions are closed degloving injuries associated with severe trauma which then present as.
Morel lavallee lesion mll is an uncommon condition consisting of a closed degloving injury caused by forces that create pressure and shear stress between the subcutaneous tissue and the. Complete obliteration of lesion was confirmed on complete absence of any free fluid on ultrasound of the affected region at 12 weeks follow up. Prepatellar swelling in a football player prepatellar swelling in a football player. Morellavallee lesion mll mimicking a soft tissue neoplasm. Morellavallee lesion is a closed degloving soft tissue injury, as a result of abrupt separation of skin and subcutaneous tissue from the underlying fascia. Posttraumatic pain at the knee is a common clinical presentation with a wide and varied differential diagnosis. Airp best cases in radiologicpathologic correlation. Morel lavallee lesions will appear as a discrete collection of fluid between the subcutaneous fat and underlying fascia. Apr 25, 2014 morellavallee lesions will appear as a discrete collection of fluid between the subcutaneous fat and underlying fascia. A 51yearold man presented with a swelling in left thigh since six years which was insidious in onset, gradually progressive in size and not associated with pain, fever or discharge.
However, similar biomechanical forces to the lumbar region, over the scapula, or over the knee can result in identical lesions and these are often also called morel lavallee lesions 1,3. The treatment for your morel lavallee lesion depends a bit on how long ago your injury was and the current nature of the lesion. A morel lavallee lesion is a closed traumatic softtissue degloving injury, caused by separation of the hypodermis from the underlying fascia. A morel lavallee lesion mll involves posttraumatic fluid collection around the greater trochanter. Mine happened july 2017 but was not discovered until oct 2017. Morellavallee lesion of the knee in a recreational frisbee. The lesions classically occur over the greater trochanter of the femur 1. It presents as a hemolymphatic mass located over the external aspect of the thigh. Mri features in five patients, which appears on page 1289 of this issue. Therefore in forensic cases with such lesions, problem may arise regarding the establishment causation link during the regulation of final report and disability reports. Pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying fascia.
It may occur by a highenergy trauma, direct bruises, or sports injuries, usually in trochanteric area. Percutaneous drainage of morellavallee lesions when the diagnosis is delayed m orel lavallee lesions are a closed internal degloving that occurs most commonly over the greater trochanter region, but can also occur in other regions, such as the knee. A morellavallee lesion is a closed degloving injury in which the skin and. We present a case demonstrating endoscopic management of this lesion. Morel lavallee lesion in children morel lavallee lesion in children. Some authors have suggested that the predilection of mll to occur in certain regions was likely related to a variation of the anatomical structure of the adipose tissue. As a result, a hematoma develops that has a high rate of acute bacterial colonization and chronic recurrence. The diagnosis of an acute morellavallee lesion is clinical. The morellavallee lesion was described by the french physician maurice morellavallee in 1853.
Most commonly, this lesion is found over the greater trochanter but can be found. Initial assessment demonstrated no significant injury. Morel lavallee lesion posttraumatic soft tissue injury first described by french physician maurice morel lavallee in 1853 1 degloving type injury where subcutaneous tissue is torn away from the underlying fascia 2 most commonly found in hippelvic region. Discussion a morel lavallee lesion is a closed degloving injury after trauma first described by victor auguste francois morel lavallee. In the hip region, there is an important type of fluid collection known as the morel.
Treatment of rare morellavallee lesion of arm with liposuction. There is separation of the skin and subcutaneous tissue from the underlying fascia resulting in an effusion and creation of a perifascial space often containing lymph and necrotic fat. In these circumstances, with nonclassic appearances of both entities, differentiation may be difficult. Dec 30, 20 morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. Nov 11, 2016 a morellavallee lesion is a closed internal degloving injury resulting from a shearing force applied to the skin. Although rare, it is possible for a sarcoma to have a high water content and appear similar to an atypical morellavallee lesion, particularly in the rare instance that the morellavallee lesion displays patchy enhancement 2, 4. The morellavallee lesion is a rare condition that was first described by the french physician maurice morellavallee in 1853. Percutaneous drainage of morellavallee lesions when the.
The space created can fill with blood, lymph and necrotic fat giving specific findings on ultrasound and magnetic resonance mr. These lesions can be visualized via computed tomography, plain film and ultrasound, but magnetic resonance imaging is the modality of choice for their identification and characterization. If in a classic location and with a characteristic appearance then little differential exists. The morellavallee lesion developed in five male patients. Morellavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. In cases where the lesion is heterogeneous in morphology or fluidfluid levels are present, the possibilities include 1,2. Mll is a rare condition consisting of a closed degloving injury caused by tangential impact and shear stress between the subcutaneous tissue and the muscle fascia or bone. The importance of morellavallee lesion in medicolegal. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the emergency department to utilize a fast, costeffective imaging technique that does not subject. Pdf the morel lavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Depending on how early the ml lesion is diagnosed, conservative therapy may be enough in its management.
The pseudocyst cavity was irrigated free of haematoma and fatty necrotic debris. Morellavallee lesions mlls were first described by french physician maurice morellavallee in 1863. Pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying. It was in my outer right thigh into my hip and buttocks by then. Our patients morellavallee lesion was evaluated with ultrasound and mri, demonstrating a predominantly hemorrhagic lesion successfully managed by aspiration. Pdf morellavallee lesions mll are rarely diagnosed posttraumatic sequel. The thigh, hip, and pelvic region are the most commonly affected locations. The morel lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee. Yes, i have being trying to find others who have went through the destruction of a morel lavallee lesion. Abstrak morellavallee lesion adalah kecederaan tisu lembut yang berlaku akibat. Traumatic swellingeffusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. Lower limb morellavallee lesion treated with shortstretch. We present two cases in which mll was missed at the initial evaluation. Morellavallee lesions mlls classically occur in the greater trochanteric region, percentage of large mlls require surgical intervention, which comes with an increased risk of skin necrosis and infection.
The morellavallee lesion mll is a rare cause of pain at the knee, caused by posttraumatic shearing of the hypodermis from the underlying fascia. Liposuction cannulas can easily drain fluid collections and could be helpful in removing necrotic tissue. The etiology of this condition may be motor vehicle accidents, falls, contact sports ie, football, wrestling, 1 and iatrogenic after mammoplasty or abdominal liposuction. We have observed that the mll also occurs in the knee as a result of shearing trauma during football, and is a distinct lesion from prepatellar bursitis and quadriceps contusion. Rapid diagnosis in the emergency department could significantly improve patient outcomes. In a 4year period, 24 mri studies of 24 consecutive. The clinical manifestation of mll varies from soft fluctuant swelling to skin necrosis or wound sepsis. Morellavallee lesion mll represents post traumatic subcutaneous cyst generally overlying bony prominences like greater trochanter, lower back, knee and scapula. Morellavallee seroma posttraumatic pseudocyst of back. The space created can fill with blood, lymph and necrotic fat giving specific.
In this condition, hemolymph is collected in the closed space between the separated subcutaneous tissue and the underlying fascia. The potential space between these tissues is subsequently filled with serous, blood, lymphatic fluid, or necrotic fat 5, 6. Article information, pdf download for management of morellavallee lesion of the. The morellavallee lesion mll is a closed traumatic softtissue degloving injury. The importance of morellavallee lesion in medicolegal evaluation. Jul 31, 2016 here we present a case of a 28yearold male presenting with a persistent type i morellavallee lesion 2. Morel lavellee lesion, pedestrian, report, causation introduction the morel lavallee lesion mll was first described by the french doctor maurice morel lavallee in 1863. It is caused by a vertical shearing force which causes closed internal. The patient was followed clinically as an outpatient, and at 6month followup he was doing well and had no evidence of recurrence of the lesion. A morel lavallee lesion is a posttraumatic soft tissue degloving injury, originally described by french surgeon victor auguste francois morel lavallee in 1863. The morellavallee lesion is a closed degloving injury that usually occurs following highenergy trauma. The french physician, victoraugustefrancois morellavallee, first described the lesion in 1863. Since morellavallee first described the lesion in the 19th century, the term has been used to describe similar lesions in other anatomic sites such as the lumbar area and over the scapula 1, 2.
Review open access morel lavallee lesion in children eun young rha1, dae ho kim2, ho kwon2 and sungno jung2 abstract morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. Many cases of mll are missed at the initial evaluation, and the treatment of mll is not well established. We describe the mri appearance of a morellavallee lesion. Mri is the mainstay of diagnosis and treatment includes both surgical and minimally invasive modalities. Nineteen patients with a morel lavallee lesion were managed with percutaneous. Doxycycline sclerodesis as a treatment option for persistent. May 16, 2015 the treatment for your morel lavallee lesion depends a bit on how long ago your injury was and the current nature of the lesion. Lesions most often occur in the peritrochanteric region, and patients may have concomitant polytrauma. The morellavallee lesion mll is a common but rarely. The readers attention is directed to the article titled longstanding morellavallee lesions of the trochanteric region and proximal thigh. Mar 26, 2015 morellavallee lesions are posttraumatic soft tissue closed degloving injuries in which the subcutaneous tissue is torn away from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. The patients were taught to retighten the compression bandage everyday till 12 weeks after which it was. The morel lavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended.
An ultrasound scan 2 days post injury revealed a large fluid collection along the lateral right thigh. A total of 16 patients with persistent morellavallee lesions i. Backgroundthe morellavallee lesion is a closed degloving injury most. Morellavallee lesions are a closed internal degloving, and open. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. Can liposuction be used to treat a morellavellee lesion. B tangential shearing force cause the relatively mobile dermis and subcutaneous fat to move relative to the fixed underlying fascia, causing disruption of perforating arteries red, veins blue, and lymphatics green. Haddadthe morel lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee. The radiologist must recognize this entity, its traumatic etiology, and treatment options. The morel lavallee lesion is a rare but important cause of calf swelling. Doppler flow activity is seen in the lesion or on the periphery.
Most commonly, mll is found over the greater trochanter and sacrum, but in rare cases can be found in other regions of the body. Endoscopic surgical management of a large morellavallee lesion. A forgotten cause of bleeding in trauma khor cc, tan tl department of emergency medicine, faculty of medicine, universiti kebangsaan malaysia medical centre, jalan yaacob latif, bandar tun razak, 56000 cheras, kuala lumpur, malaysia. Mechanism of morellavallee seroma lesion case courtesy of dr matt skalski, rid. The morel lavallee lesion mll is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. At one month, if there is a persistent fluid collection, then this may have become encapsulated. Morel lavallee lesions, strictly speaking, occur in the thigh. Delayed presentation of a chronic morellavallee lesion.