Mri is the mainstay of diagnosis and treatment includes both surgical and minimally invasive modalities. Morellavallee lesion of the knee in a recreational frisbee. 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. Therefore in forensic cases with such lesions, problem may arise regarding the establishment causation link during the regulation of final report and disability reports. The clinical manifestation of mll varies from soft fluctuant swelling to skin necrosis or wound sepsis. Pdf morellavallee lesions mll are rarely diagnosed posttraumatic sequel. The morel lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee. 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. Pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying fascia. The importance of morellavallee lesion in medicolegal evaluation. Can liposuction be used to treat a morellavellee lesion. The space created can fill with blood, lymph and necrotic fat giving specific. The space created can fill with blood, lymph and necrotic fat giving specific findings on ultrasound and magnetic resonance mr.
Delayed presentation of a chronic morellavallee lesion. Due to its inconsistent clinical manifestations and. 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. 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. The thigh, hip, and pelvic region are the most commonly affected locations. Morel lavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. Initial assessment demonstrated no significant injury. 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. The etiology of this condition may be motor vehicle accidents, falls, contact sports ie, football, wrestling, 1 and iatrogenic after mammoplasty or abdominal liposuction. The morel lavallee lesion mll is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma.
The morel lavallee lesion is a rare but important cause of calf swelling. We describe the mri appearance of a morellavallee lesion. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. The morellavallee lesion mll is a closed traumatic softtissue degloving injury. Morel lavellee lesion, pedestrian, report, causation introduction the morel lavallee lesion mll was first described by the french doctor maurice morel lavallee in 1863. Backgroundthe morellavallee lesion is a closed degloving injury most. 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. Review open access morellavallee lesion in children. It most frequently occurs in the peritrochanteric region along the proximal lateral thigh, such as in this ct scan. Our patients morellavallee lesion was evaluated with ultrasound and mri, demonstrating a predominantly hemorrhagic lesion successfully managed by aspiration. Doxycycline sclerodesis as a treatment option for persistent.
The readers attention is directed to the article titled longstanding morellavallee lesions of the trochanteric region and proximal thigh. Rapid diagnosis in the emergency department could significantly improve patient outcomes. 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. It was in my outer right thigh into my hip and buttocks by then. The morellavallee lesion is a rare condition that was first described by the french physician maurice morellavallee in 1853. Posttraumatic pain at the knee is a common clinical presentation with a wide and varied differential diagnosis. Morellavallee lesion mll represents post traumatic subcutaneous cyst generally overlying bony prominences like greater trochanter, lower back, knee and scapula. Similar to ultrasonographic imaging, fat and debris may be visualized as well as fluidfluid levels. Morel lavallee lesion in children morel lavallee lesion in children. Nov 11, 2016 a morellavallee lesion is a closed internal degloving injury resulting from a shearing force applied to the skin. 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. The morel lavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma.
Pdf the morel lavallee lesion is a closed softtissue degloving injury commonly associated with highenergy trauma. Traumatic swellingeffusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. The morellavallee lesion is a closed degloving injury that usually occurs following highenergy trauma. The morellavallee lesion developed in five male patients. As a result, a hematoma develops that has a high rate of acute bacterial colonization and chronic recurrence.
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. Depending on how early the ml lesion is diagnosed, conservative therapy may be enough in its management. Article information, pdf download for management of morellavallee lesion of the. Morellavallee lesions are a closed internal degloving, and open. 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. An ultrasound scan 2 days post injury revealed a large fluid collection along the lateral right thigh. 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. Yes, i have being trying to find others who have went through the destruction of a morel lavallee lesion. The morellavallee lesion mll is a rare cause of pain at the knee, caused by posttraumatic shearing of the hypodermis from the underlying fascia. Mine happened july 2017 but was not discovered until oct 2017. Jul 31, 2016 here we present a case of a 28yearold male presenting with a persistent type i morellavallee lesion 2. We present two cases in which mll was missed at the initial evaluation. It presents as a hemolymphatic mass located over the external aspect of the thigh.
Abstrak morellavallee lesion adalah kecederaan tisu lembut yang berlaku akibat. In the hip region, there is an important type of fluid collection known as the morel. Pdf morellavallee lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying. Discussion a morel lavallee lesion is a closed degloving injury after trauma first described by victor auguste francois morel lavallee. The lesions classically occur over the greater trochanter of the femur 1. If in a classic location and with a characteristic appearance then little differential exists. 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. Timely identification and management of a morel lavallee lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. Sonography can be effectively used to diagnose and characterize soft tissue fluid collections.
Dec 30, 20 morel lavallee lesion mll is a closed degloving injury resulting from blunt shearing or tangential forces. A morellavallee lesion is a closed degloving injury in which the skin and. In these circumstances, with nonclassic appearances of both entities, differentiation may be difficult. The radiologist must recognize this entity, its traumatic etiology, and treatment options. Morellavallee lesions are closed degloving injuries associated with severe trauma which then present as. Nineteen patients with a morel lavallee lesion were managed with percutaneous. The treatment for your morel lavallee lesion depends a bit on how long ago your injury was and the current nature of the lesion. Haddadthe morel lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee. 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. Prepatellar swelling in a football player prepatellar swelling in a football player. In a 4year period, 24 mri studies of 24 consecutive. Lower limb morellavallee lesion treated with shortstretch. The diagnosis of an acute morellavallee lesion is clinical. In this condition, hemolymph is collected in the closed space between the separated subcutaneous tissue and the underlying fascia.
A morel lavallee lesion is a posttraumatic soft tissue degloving injury, originally described by french surgeon victor auguste francois morel lavallee in 1863. It was first described in 1848 by victoraugustefrancois morellavallee 18111865, a french surgeon 4. 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. We present a case demonstrating endoscopic management of this lesion.
The morellavallee lesion mll is a common but rarely. Morellavallee lesions are a relatively rare clinical problem, referring to. 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. Airp best cases in radiologicpathologic correlation. Most of the patients sustained the lesion over the thigh followed by trochanteric region, lower back, and abdominal wall. Many cases of mll are missed at the initial evaluation, and the treatment of mll is not well established. The potential space between these tissues is subsequently filled with serous, blood, lymphatic fluid, or necrotic fat 5, 6. The pseudocyst cavity was irrigated free of haematoma and fatty necrotic debris. Treatment of rare morellavallee lesion of arm with liposuction.
Mechanism of morellavallee seroma lesion case courtesy of dr matt skalski, rid. 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. In cases where the lesion is heterogeneous in morphology or fluidfluid levels are present, the possibilities include 1,2. 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. Morel lavallee lesions, strictly speaking, occur in the thigh. Morellavallee syndrome or lesion was first described by a french surgeon, victor morel lavallee, in 1863. Complete obliteration of lesion was confirmed on complete absence of any free fluid on ultrasound of the affected region at 12 weeks follow up. The morellavallee lesion was described by the french physician maurice morellavallee in 1853. Endoscopic surgical management of a large morellavallee lesion. It may occur by a highenergy trauma, direct bruises, or sports injuries, usually in trochanteric area.
The french physician, victoraugustefrancois morellavallee, first described the lesion in 1863. 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. We report a rare case of a large mll that was successfully treated with compression. Morellavallee seroma posttraumatic pseudocyst of back. 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. Most commonly, this lesion is found over the greater trochanter but can be found. Apr 25, 2014 morellavallee lesions will appear as a discrete collection of fluid between the subcutaneous fat and underlying fascia. Liposuction cannulas can easily drain fluid collections and could be helpful in removing necrotic tissue. It is caused by a vertical shearing force which causes closed internal. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. At one month, if there is a persistent fluid collection, then this may have become encapsulated. The patients were taught to retighten the compression bandage everyday till 12 weeks after which it was.
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. Most commonly, mll is found over the greater trochanter and sacrum, but in rare cases can be found in other regions of the body. Lesions most often occur in the peritrochanteric region, and patients may have concomitant polytrauma. A total of 16 patients with persistent morellavallee lesions i. 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. Morel lavallee lesions will appear as a discrete collection of fluid between the subcutaneous fat and underlying fascia. The importance of morellavallee lesion in medicolegal. Mri features in five patients, which appears on page 1289 of this issue. Percutaneous drainage of morellavallee lesions when the.
Ethical clearance was obtained from the institutional ethical committee. Doppler flow activity is seen in the lesion or on the periphery. 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. Morellavallee lesions mlls were first described by french physician maurice morellavallee in 1863. We have observed that the mll also occurs in the knee as a result of shearing trauma during football, and is a distinct lesion.
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