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01-02-2014 | Review Article

The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options

Authors: Iris Bonilla-Yoon, Sulabha Masih, Dakshesh B. Patel, Eric A. White, Benjamin D. Levine, Kira Chow, Christopher J. Gottsegen, George R. Matcuk Jr.

Published in: Emergency Radiology | Issue 1/2014

Abstract

Morel-Lavallée lesions are posttraumatic hemolymphatic collections related to shearing injury and disruption of interfascial planes between subcutaneous soft tissue and muscle. We review the pathophysiology of Morel-Lavallée lesions, clinical presentation, and potential sites of involvement. Magnetic resonance imaging (MRI) is the modality of choice for characterization. We present the MRI classification and highlight the key imaging features that distinguish the different types, focusing on the three most common: seroma, subacute hematoma, and chronic organizing hematoma. Potential mimics of Morel-Lavallée lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed.

Morel-Lavallée M (1863) Decollements traumatiques de la peau et des couches sousjacentes. Arch Gen Med 1:20–38, 172–200, 300–332

Kalaci A, Karazincir S, Yanat AN (2007) Long-standing Morel-Lavallee lesion of the thigh simulating a neoplasm. Clin Imaging 31(4):287–291PubMedCrossRef

Parra JA, Fernandez MA, Encinas B, Rico M (1997) Morel-Lavallee effusions in the thigh. Skelet Radiol 26(4):239–241CrossRef

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):1162–1167PubMedCrossRef

Matava MJ, Ellis E, Shah NR, Pogue D, Williams T (2010) Morel-Lavallee lesion in a professional American football player. Am J Orthop 39(3):144–147PubMed

Moriarty JM, Borrero CG, Kavanagh EC (2011) A rare cause of calf swelling: the Morel-Lavallee lesion. Ir J Med Sci 180(1):265–268PubMedCentralPubMedCrossRef

Hudson DA, Knottenbelt JD, Krige JE (1992) Closed degloving injuries: results following conservative surgery. Plast Reconstr Surg 89(5):853–855PubMedCrossRef

Hak DJ, Olson SA, Matta JM (1997) Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures: the Morel-Lavallee lesion. J Trauma 42(6):1046–1051PubMedCrossRef

Phillips TJ, Jeffcote B, Collopy D (2008) Bilateral Morel-Lavallee lesions after complex pelvic trauma: a case report. J Trauma 65(3):708–711PubMedCrossRef

10.

Tsur A, Galin A, Kogan L, Loberant N (2006) [Morel-Lavallee syndrome after crush injury]. Harefuah 145(2):111–113, 166PubMed

11.

Beaulieu S, De Parades V, Manaouil D, Parisot C, Atienza P (2001) [Retrosacral hematoma of Morel-Lavallee: a rare cause of perianal sepsis]. Gastroenterol Clin Biol 25(11):1031–1032PubMed

12.

Fornecker C, Griffon C, Knauer V, Stephan D (2006) [Morel-Lavallee syndrome, an unusual differential diagnosis for deep vein thrombosis]. J Mal Vasc 31(2):98–100PubMedCrossRef

13.

Borrero CG, Maxwell N, Kavanagh E (2008) MRI findings of prepatellar Morel-Lavallee effusions. Skelet Radiol 37(5):451–455CrossRef

14.

Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS (2012) The Morel-Lavallee lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop 2012:593193PubMedCentralPubMed

15.

Ciaschini M, Sundaram M (2008) Radiologic case study. Prepatellar Morel-Lavallee lesion. Orthopedics 31(7):626, 719–721PubMed

16.

van Gennip S, van Bokhoven SC, van den Eede E (2012) Pain at the knee: the Morel-Lavallee lesion, a case series. Clin J Sport Med Off J Can Acad Sport Med 22(2):163–166CrossRef

17.

Yahyavi-Firouz-Abadi N, Demertzis JL (2013) Prepatellar Morel-Lavallee effusion. Skelet Radiol 42(1):127–128, 151–152CrossRef

18.

Anakwenze OA, Trivedi V, Goodman AM, Ganley TJ (2011) Concealed degloving injury (the Morel-Lavallee lesion) in childhood sports: a case report. J Bone Jt Surg Am Vol 93(24):e148CrossRef

19.

Powers ML, Hatem SF, Sundaram M (2007) Morel-Lavallee lesion. Orthopedics 30(4):250, 322–323PubMed

20.

Efrimescu CI, McAndrew J, Bitzidis A (2012) Acute lumbar Morel-Lavallee haematoma in a 14-year-old boy. Emerg Med J EMJ 29(5):433CrossRef

21.

Moran DE, Napier NA, Kavanagh EC (2012) Lumbar Morel-Lavallee effusion. Spine J Off J N Am Spine Soc 12(12):1165–1166CrossRef

22.

Sawkar AA, Swischuk LE, Jadhav SP (2011) Morel-Lavallee seroma: a review of two cases in the lumbar region in the adolescent. Emerg Radiol 18(6):495–498PubMedCrossRef

23.

Scaranelo AM, Davanco RA (2005) Pseudocyst formation after abdominal liposuction–extravasations of Morel-Lavallee on MR images. Br J Plast Surg 58(6):849–851PubMedCrossRef

24.

Zecha PJ, Missotten FE (1999) Pseudocyst formation after abdominoplasty–extravasations of Morel-Lavallee. Br J Plast Surg 52(6):500–502PubMedCrossRef

25.

Archier E, Grillo JC, Fourcade S, Gaudy C, Grob JJ, Richard MA (2012) [Morel-Lavallee syndrome of the lower leg]. Ann Dermatol Venereol 139(3):216–220PubMedCrossRef

26.

Molnar SL, Recarte A, Villafane O, Lecumberri P, Csernatony Z (2011) Morel-Lavallee syndrome of the tibia. BMJ Case Rep. doi:10.1136/bcr.05.2011.4227

27.

Gosain AK, Yan JG, Aydin MA, Das DK, Sanger JR (2002) The vascular supply of the extended tensor fasciae latae flap: how far can the skin paddle extend? Plast Reconstr Surg 110(7):1655–1661, discussion 1662–1653PubMedCrossRef

28.

Mellado JM, Bencardino JT (2005) Morel-Lavallee lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin N Am 13(4):775–782PubMedCrossRef

29.

Mellado JM, Perez del Palomar L, Diaz L, Ramos A, Sauri A (2004) Long-standing Morel-Lavallee lesions of the trochanteric region and proximal thigh: MRI features in five patients. AJR Am J Roentgenol 182(5):1289–1294PubMedCrossRef

30.

Mukherjee K, Perrin SM, Hughes PM (2007) Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation. Skelet Radiol 36(Suppl 1):S43–S45CrossRef

31.

Choudhary AK, Methratta S (2010) Morel-Lavallee lesion of the thigh: characteristic findings on US. Pediatr Radiol 40(Suppl 1):S49PubMedCrossRef

32.

Goodman BS, Smith MT, Mallempati S, Nuthakki P (2013) A comparison of ultrasound and magnetic resonance imaging findings of a Morel-Lavallee lesion of the knee. PM & R J Inj Funct Rehabil 5(1):70–73CrossRef

33.

Neal C, Jacobson JA, Brandon C, Kalume-Brigido M, Morag Y, Girish G (2008) Sonography of Morel-Lavallee lesions. J Ultrasound Med Off J Am Inst Ultrasound Med 27(7):1077–1081

34.

Puig J, Pelaez I, Banos J, Balliu E, Casas M, Maroto A et al (2006) Long-standing Morel-Lavallee lesion in the proximal thigh: ultrasound and MR findings with surgical and histopathological correlation. Australas Radiol 50(6):594–597PubMedCrossRef

35.

Chokshi FH, Jose J, Clifford PD (2010) Morel-Lavallee lesion. Am J Orthop 39(5):252–253PubMed

36.

Mankad K, Hoey E, Grainger AJ, Barron DA (2008) Trauma musculoskeletal ultrasound. Emerg Radiol 15(2):83–89PubMedCrossRef

37.

Reddix RN Jr, Carroll E, Webb LX (2009) Early diagnosis of a Morel-Lavallee lesion using three-dimensional computed tomography reconstructions: a case report. J Trauma 67(2):E57–E59PubMedCrossRef

38.

Rubin JI, Gomori JM, Grossman RI, Gefter WB, Kressel HY (1987) High-field MR imaging of extracranial hematomas. AJR Am J Roentgenol 148(4):813–817PubMedCrossRef

39.

Bush CH (2000) The magnetic resonance imaging of musculoskeletal hemorrhage. Skelet Radiol 29(1):1–9CrossRef

40.

Donahue F, Turkel D, Mnaymneh W, Ghandur-Mnaymneh L (1996) Hemorrhagic prepatellar bursitis. Skelet Radiol 25(3):298–301CrossRef

41.

Tsai TS, Evans HA, Donnelly LF, Bisset GS 3rd, Emery KH (1997) Fat necrosis after trauma: a benign cause of palpable lumps in children. AJR Am J Roentgenol 169(6):1623–1626PubMedCrossRef

42.

Dawre S LS, H S, Gupta S, Gupta AK (2012) The Morel-Lavallee lesion: a review and proposed algorithmic approach. Eur J Plast Surg 35:489–494

43.

Ronceray J (1976) [Active drainage by partial aponeurotic resection of Morel-Lavallee effusions]. Nouv Press Med 5(20):1305–1306

44.

Penaud A, Quignon R, Danin A, Bahe L, Zakine G (2011) Alcohol sclerodhesis: an innovative treatment for chronic Morel-Lavallee lesions. J Plast Reconstr Aesth Surg JPRAS 64(10):e262–e264CrossRef

45.

Bansal A, Bhatia N, Singh A, Singh AK (2013) Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallee lesions. Injury 44(1):66–69PubMedCrossRef

46.

Shen C, Peng JP, Chen XD (2013) Efficacy of treatment in peri-pelvic Morel-Lavallee lesion: a systematic review of the literature. Arch Orthop Trauma Surg 133(5):635–640PubMedCrossRef

47.

Isaacson AJ, Stavas JM (2013) Image-guided drainage and sclerodesis of a Morel-Lavallee lesion. J Vasc Interv Radiol JVIR 24(4):605–606CrossRef

48.

Kohler D, Pohlemann T (2010) Operative treatment of the peripelvic Morel-Lavallee lesion. Oper Orthop Traumatol 23(1):15–20

49.

Tseng S, Tornetta P 3rd (2006) Percutaneous management of Morel-Lavallee lesions. J Bone Jt Surg Am Vol 88(1):92–96CrossRef

50.

Jones RM, Hart AM (2012) Surgical treatment of a Morel-Lavallee lesion of the distal thigh with the use of lymphatic mapping and fibrin sealant. J Plast Reconstr Aesth Surg JPRAS 65(11):1589–1591CrossRef

51.

Luria S, Applbaum Y, Weil Y, Liebergall M, Peyser A (2006) Talc sclerodhesis of persistent Morel-Lavallee lesions (posttraumatic pseudocysts): case report of 4 patients. J Orthop Trauma 20(6):435–438PubMedCrossRef

52.

Harma A, Inan M, Ertem K (2004) [The Morel-Lavallee lesion: a conservative approach to closed degloving injuries]. Acta Orthop Traumatol Turc 38(4):270–273PubMed

53.

Coulibaly NF, Sankale AA, Sy MH, Kinkpe CV, Kasse AN, Diouf S et al (2011) [Morel-Lavallee lesion in orthopaedic surgery (nineteen cases)]. Ann Chir Plast Esthet 56(1):27–32PubMedCrossRef

54.

Demirel M, Dereboy F, Ozturk A, Turhan E, Yazar T (2007) Morel-Lavallee lesion. Results of surgical drainage with the use of synthetic glue. Saudi Med J 28(1):65–67PubMed

55.

Tran W, Foran J, Wang M, Schwartz A (2008) Postsurgical bleeding following treatment of a chronic Morel-Lavallee lesion. Orthopedics 31(8):814PubMedCrossRef

56.

Zhu Y, Xu Y, Li J, Dai Y, Yang X, Zhao H (2010) [Surgical treatment of Morel-Lavallee lesion with perineal lacerations]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(6):726–729PubMed

Title: The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options
Authors: Iris Bonilla-Yoon
Sulabha Masih
Dakshesh B. Patel
Eric A. White
Benjamin D. Levine
Kira Chow
Christopher J. Gottsegen
George R. Matcuk Jr.
Publication date: 01-02-2014
Publisher: Springer Berlin Heidelberg
Published in: Emergency Radiology / Issue 1/2014
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-013-1151-7

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The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options

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