MOrel-lavallee lesions
introduction
Case Vignette
A) Knee
B) Shoulder
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 [7]. 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%) [8].
physical examination
imaging
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[10].
treatment
Summary
Case Conclusion
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%).
References
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- 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.