C) Greater trochanter
D) Lower leg
MLLs occur most frequently over the greater trochanter region along the proximal lateral thigh. This is thought to be due to the large surface area, mobility of the skin and dense capillary network within the soft tissue of the proximal thigh and gluteal region . Vanhegan et al reviewed more than 200 MLLs reported in the literature and noted their presence in the following regions: the greater trochanter/hip (30.4%), thigh (20.1%), pelvis (18.6%), knee (15.7%), gluteal region (6.4%), lumbosacral area (3.4%), abdominal (1.4%) and calf/lower leg (1.4%) .
Many different types of imaging modalities have been used to assist in the diagnosis of MLLs and any concurrent conditions. These include ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). Plain radiography may show a nonspecific soft tissue mass, which may indicate further diagnostic tests or a possible underlying fracture. Many times plain radiographs are done of the region to rule out any fractures or bony lesions. CT can also be used in a similar manner and MLL appears as a well-defined, encapsulated fluid collection that occasionally shows fluid levels on CT resulting from sedimentation of cellular blood components.
Correct answer: C. The vignette is describing a Morel-Lavalee lesion, a closed soft-tissue degloving injury that results in the separation of the hypodermis from the underlying fascia and most commonly occurs around the hips and pelvis. The greater trochanter is the most common region affected, with the thigh and pelvis next most common. Vanhegan et al. reviewed more than 200 MLLs reported in the literature and noted their presence in the following regions: the greater trochanter/hip (30.4%), thigh (20.1%), pelvis (18.6%), knee (15.7%), gluteal region (6.4%), lumbosacral area (3.4%), abdominal (1.4%) and calf/lower leg (1.4%).
1. Morel-Lavallee M (1863) Decollements traumatiques de la peau et des couches sousjacentes. Arch Gen Med 1:20–38, 172–200, 300–332
- Letournel E JR. Fractures of the Acetabulum. 2nd ed. Berlin, Germany: Springer-Verlag; 1993
- Li, Hui, Fangjie Zhang, and Guanghua Lei. “Morel-lavallee lesion.” Chinese medical journal 127.7 (2014): 1351-1356.
- Hak DJ, Olson SA, Matta JM. Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures: the Morel-Lavallee lesion. J Trauma 1997; 42: 1046-1051.
- Van Gennip S, Van Bokhoven SC, Van Den Eede E. Pain at the knee: the Morel-Lavallee lesion, a case series. Clin J Sport Med 2012; 22: 163-166
- Anakwenze OA, Trivedi V, Goodman AM, Ganley TJ. Concealed degloving injury (the Morel-Lavallee lesion) in childhood sports: a case report. J Bone Joint Surg Am 2011; 93: e141-e148.
- Scolaro, John A. MD, MA; Chao, Tom MD; Zamorano, David P. MD The Morel-Lavallée Lesion: Diagnosis and Management, Journal of the American Academy of Orthopaedic Surgeons: October 2016 – Volume 24 – Issue 10 – p 667-672 doi: 10.5435/JAAOS-D-15-00181
- Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS: The Morel-Lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: Case report and literature review. Case Rep Orthop 2012;2012:593193.23320230
- Hudson DA: Missed closed degloving injuries: Late presentation as a contour deformity. Plast Reconstr Surg 1996;98(2):334-337.8764723
- Luria S, Yaakov A, Yoram W, Meir L, Peyser A. Talc sclerodhesis of persistent Morel-Lavallee lesions (posttraumatic pseudocysts): case report of 4 patients. J Orthop Trauma 2006; 20: 435-438.
- Parra JA, Fernandez MA, Encinas B, Rico M. Morel-Lavallee effusions in the thigh. Skeletal Radiol 1997; 26: 239-241.
- Neal C, Jacobson JA, Brandon C, Kalume-Brigido M, Morag Y, Girish G. Sonography of Morel-Lavallee lesions. J Ultrasound Med 2008; 27: 1077-1081.
13. Dawre, Sandeep, et al. “The Morel-Lavallee lesion: a review and a proposed algorithmic approach.” European Journal of Plastic Surgery 35.7 (2012): 489-494.
- Mellado JM, Bencardino JT (2005) Morel–Lavallee lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin N Am 13:775–782
- Tejwani SG, Cohen SB, Bradley JP (2007) Management of Morel– Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med 35(7):1162–1167, Epub 2007 Mar 9
- Harma A, Inan M, Ertem K (2004) The Morel-Lavallee lesion: a conservative approach to closed degloving injuries. Acta Orthop Traumatol Turc 38:270–273
- Jovanović M, Janjić Z, Vučković N (2007) Giant post-traumatic cyst after closed degloving injury. Arch Oncol 15(1–2):42–44
- Haddad FJ, Younes RN, Gross JL, Deheinzelim D (2004) Pleurodesis in patients with malignant pleural effusions: talc slurry or bleomycin? Results of a prospective randomized trial. World J Surg 28:749–753
- Bansal A, Bhatia N, Singh A, Singh AK (2011) Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallée lesions. Injury.
- Penaud A, Quignon R, Danin A, Bahe L, Zakine G (2011) Alcohol sclerodesis: an innovative treatment for chronic Morel-Lavallée lesions. J Plast Reconstr Aesthet Surg 64(10):e262–e264, Epub 2011 Jul 7
- Carlson DA, Simmons J, Sando W, Weber T, Clements B: Morel-Lavalée lesions treated with debridement and meticulous dead space closure: Surgical technique. J Orthop Trauma 2007;21(2):140-144.17304071
- Tseng S, Tornetta P III: Percutaneous management of Morel-Lavallee lesions. J Bone Joint Surg Am 2006;88(1):92-96.16391253
- Shen C, Peng JP, Chen XD: Efficacy of treatment in peri-pelvic Morel-Lavallee lesion: A systematic review of the literature. Arch Orthop Trauma Surg 2013;133(5):635-640.23443527
- Christian D, Leland HA, Osias W, Eberlin S, Howell L. Delayed Presentation of a Chronic Morel-Lavallée Lesion. Journal of Radiology Case Reports. 2016 Jul;10(7):30-39. DOI: 10.3941/jrcr.v10i7.2698. PMID: 27761187; PMCID: PMC5065277.