Morel-Lavallée lesion

Background

• Posttraumatic, closed degloving injury
• Results in subcutaneous fluid collection after abrupt separation of skin and subcutaneous tissues from underlying fascia
  • Disrupts capillaries and lymphatics resulting in leakage of lymph, blood, and necrotic fat
• Most commonly seen in proximal thigh or overlying hip
  • Also reported in trunk, prepatellar region, lumbar region, or scapular regions
• If not diagnosed early, can become infected

Clinical Features

• Enlarging, painful area of swelling
• Soft tissue fluctuance
• Associated with high-energy, blunt trauma with or without associated fracture

Differential Diagnosis

• Hematoma
• Hemangioma/Vascular malformation
• Tumor
• Cyst
• Abscess
• Deep venous thrombosis
• Compartment syndrome
• Septic joint
• Necrotizing fasciitis

Extremity trauma

• Compartment syndrome
• Contusion
• Crush syndrome
• Degloving injury
  • Morel-Lavallée lesion
  • Ring avulsion injury
• Fracture
  • Open fracture
• Laceration
• Myositis ossificans
• Open joint injury
• Peripheral nerve injury
• Rhabdomyolysis
• Tendon injury
• Vascular injury

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Evaluation

Morel-Lavallee lesion is a closed traumatic soft-tissue degloving injury, caused by separation of the hypodermis from the underlying fascia. It most frequently occurs in the peritrochanteric region along the proximal lateral thigh, such as in this CT scan.

• Evaluate for tenderness, fluctuance
• Labs
  • CBC- can have significant bleeding into the lesion, watch Hb
• Imaging
  • MRI is modality of choice for evaluation, but these lesions are also visible on CT
  • Ultrasound can show a fluid collection, but can't be used to rule out

Management

• Will require surgical consultation and drainage

Disposition

• Admit