Morel-Lavallée lesion: Difference between revisions

(Defintion, epidemiology/aetiology, pathophysiology added)
(clinical presentation, complications and classification added)
Line 5: Line 5:
A Morel-Lavallée lesion (MLL) was first described in 1853<ref name=":0">Diviti S, Gupta N, Hooda K, Sharma K, Lo L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449878/pdf/jcdr-11-TE01.pdf Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management]. Journal of clinical and diagnostic research: JCDR. 2017 Apr;11(4):TE01.</ref> <ref name=":1">Singh R, Rymer B, Youssef B, Lim J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126206/pdf/main.pdf The Morel-Lavallée lesion and its management: a review of the literature]. Journal of orthopaedics. 2018 Dec 1;15(4):917-21.</ref>. It is a closed soft-tissue degloving injury<ref name=":0" /><ref name=":2">Zairi F, Wang Z, Shedid D, Boubez G, Sunna T. [https://reader.elsevier.com/reader/sd/pii/S1877056816000335?token=193AFCCCD9D35EF9227D6E4A8B2D40CD82BE93612C9E4AE3D66FCFDFAE18AF664140FDCB451AEEEC9F156AAC2CD3531C&originRegion=eu-west-1&originCreation=20221125075833 Lumbar Morel-Lavallée lesion: case report and review of the literature]. Orthopaedics & Traumatology: Surgery & Research. 2016 Jun 1;102(4):525-7.</ref><ref name=":3">LaTulip S, Rao RR, Sielaff A, Theyyunni N, Burkhardt J. [https://downloads.hindawi.com/journals/criem/2017/3967587.pdf Ultrasound utility in the diagnosis of a Morel-Lavallée lesion]. Case Reports in Emergency Medicine. 2017 Feb 1;2017.</ref><ref name=":4">Depaoli R, Canepari E, Bortolotto C, Ferrozzi G. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353822/pdf/40477_2015_Article_157.pdf Morel-Lavallée lesion of the knee in a soccer player]. Journal of ultrasound. 2015 Mar;18(1):87-9.</ref><ref name=":5">Mettu R, Surath HV, Chayam HR, Surath A. [https://www.researchgate.net/publication/320866983_Chronic_Morel-Lavallee_Lesion_A_Novel_Minimally_Invasive_Method_of_Treatment Chronic Morel-Lavallée lesion: a novel minimally invasive method of treatment]. Wounds. 2016 Nov 1;28(11):404-7.</ref> that usually occurs after blunt trauma<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":4" />. In recent literature, it can also be referred to as  Morel-Lavallée seroma or effusion, post-traumatic soft tissue cysts or post-traumatic extravasations<ref name=":1" />.  
A Morel-Lavallée lesion (MLL) was first described in 1853<ref name=":0">Diviti S, Gupta N, Hooda K, Sharma K, Lo L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449878/pdf/jcdr-11-TE01.pdf Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management]. Journal of clinical and diagnostic research: JCDR. 2017 Apr;11(4):TE01.</ref> <ref name=":1">Singh R, Rymer B, Youssef B, Lim J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126206/pdf/main.pdf The Morel-Lavallée lesion and its management: a review of the literature]. Journal of orthopaedics. 2018 Dec 1;15(4):917-21.</ref>. It is a closed soft-tissue degloving injury<ref name=":0" /><ref name=":2">Zairi F, Wang Z, Shedid D, Boubez G, Sunna T. [https://reader.elsevier.com/reader/sd/pii/S1877056816000335?token=193AFCCCD9D35EF9227D6E4A8B2D40CD82BE93612C9E4AE3D66FCFDFAE18AF664140FDCB451AEEEC9F156AAC2CD3531C&originRegion=eu-west-1&originCreation=20221125075833 Lumbar Morel-Lavallée lesion: case report and review of the literature]. Orthopaedics & Traumatology: Surgery & Research. 2016 Jun 1;102(4):525-7.</ref><ref name=":3">LaTulip S, Rao RR, Sielaff A, Theyyunni N, Burkhardt J. [https://downloads.hindawi.com/journals/criem/2017/3967587.pdf Ultrasound utility in the diagnosis of a Morel-Lavallée lesion]. Case Reports in Emergency Medicine. 2017 Feb 1;2017.</ref><ref name=":4">Depaoli R, Canepari E, Bortolotto C, Ferrozzi G. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353822/pdf/40477_2015_Article_157.pdf Morel-Lavallée lesion of the knee in a soccer player]. Journal of ultrasound. 2015 Mar;18(1):87-9.</ref><ref name=":5">Mettu R, Surath HV, Chayam HR, Surath A. [https://www.researchgate.net/publication/320866983_Chronic_Morel-Lavallee_Lesion_A_Novel_Minimally_Invasive_Method_of_Treatment Chronic Morel-Lavallée lesion: a novel minimally invasive method of treatment]. Wounds. 2016 Nov 1;28(11):404-7.</ref> that usually occurs after blunt trauma<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref name=":4" />. In recent literature, it can also be referred to as  Morel-Lavallée seroma or effusion, post-traumatic soft tissue cysts or post-traumatic extravasations<ref name=":1" />.  
== Epidemiology and aetiology ==
== Epidemiology and aetiology ==
These injuries are uncommon<ref name=":1" /> and there is no consensus on the ratio of men to women. One source reported a 2:1 ratio<ref name=":1" /> while another reported a 1:1 ratio<ref>Christian D, Leland HA, Osias W, Eberlin S, Howell L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065277/pdf/jrcr-10-7-30.pdf Delayed presentation of a chronic Morel-Lavallee lesion]. Journal of Radiology Case Reports. 2016 Jul;10(7):30.</ref>.
These injuries are uncommon<ref name=":1" /> and there is no consensus on the ratio of men to women. One source reported a 2:1 ratio<ref name=":1" /> while another reported a 1:1 ratio<ref name=":10">Christian D, Leland HA, Osias W, Eberlin S, Howell L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065277/pdf/jrcr-10-7-30.pdf Delayed presentation of a chronic Morel-Lavallee lesion]. Journal of Radiology Case Reports. 2016 Jul;10(7):30.</ref>.


These injuries occur due to blunt trauma after:
These injuries occur due to blunt trauma after:
Line 22: Line 22:


Secondary risk factors for an MLL include female gender and BMI of over 25<ref name=":0" />.
Secondary risk factors for an MLL include female gender and BMI of over 25<ref name=":0" />.


== Clinical Presentation  ==
== Clinical Presentation  ==
MLL occurs most commonly over the greater trochanter (>60% of cases) (1,2,5,6,8,11), proximal femur (2,5,1,), buttock (2,3,6), knee (2,6,8,11) and in rare cases, the lumbar region (2,3,6,11). It can also occur at the scapula (3,8). Delayed presentation (months or years) can occur in up to ⅓ of patients (1,5). The most common signs and symptoms include:
[[File:Morel-lavallee sites.jpg|thumb|400x400px|Case courtesy of Dr Matt Skalski, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22762?lang=us">rID: 22762</a>]]
MLL occurs most commonly over the greater trochanter (>60% of cases)<ref name=":0" /><ref name=":2" /> <ref name=":4" /><ref name=":5" /><ref name=":6" /><ref name=":9" />, proximal femur<ref name=":0" /><ref name=":1" /><ref name=":4" />, buttock<ref name=":1" /><ref name=":2" /><ref name=":4" />, knee<ref name=":2" /><ref name=":4" /><ref name=":5" /><ref name=":9" /> and in rare cases, the lumbar region<ref name=":1" /><ref name=":2" /><ref name=":5" /><ref name=":9" />. It can also occur at the scapula<ref name=":1" /><ref name=":5" />. Delayed presentation (months or years) can occur in up to ⅓ of patients<ref name=":0" /><ref name=":6" />. The most common signs and symptoms include:
 
* Compressible, fluctuant swollen area<ref name=":0" /><ref name=":1" /><ref name=":4" /><ref name=":6" /><ref name=":7" />. The fluctuant swelling is an essential clinical characteristic<ref name=":7" />.
* Pain<ref name=":0" /><ref name=":1" /><ref name=":3" /><ref name=":6" />
* Stiffness<ref name=":4" /><ref name=":7" />
* Cutaneous anaesthesia or hypothesia may be present<ref name=":0" /><ref name=":1" /><ref name=":3" /><ref name=":6" />
* Ecchymosis may be present<ref name=":7" />
* Abrasions may be present<ref name=":7" />
* Secondary dermal changes e.g. discolouration, frank necrosis, drying/cracking<ref name=":0" /><ref name=":7" />
 
== Complications ==
The necrotic tissue associated with the MLL is particularly susceptible to infection<ref name=":2" /> and if infection occurs, it can lead to


* Pain (1,3,,45)
* Cellulitis<ref name=":2" />
* Swelling (1,4,5)
* Abscess<ref name=":2" />
* Stiffness (6,13)
* Osteomyelitis<ref name=":2" />
* Cutaneous anaesthesia or hypothesia may be present (1,3,4,5)
* Necrosis of underlying tissues due to pressure<ref name=":7" />
* Ecchymosis may be present (13)
* Abrasions may be present (13)
* Secondary dermal changes e.g. discolouration, frank necrosis, drying/cracking (1,13)


* Compressible, fluctuant swollen area  (1,3,5,6,13). The fluctuant swelling is an essential clinical characteristic (13)
== Classification ==


== Complications ==
Mellado and Bencardino proposed a MRI classification and identified 6 types of MLL based on the lesion chronicity, appearance on MRI and tissue composition <ref name=":1" /><ref name=":10" /><ref name=":6" /><ref name=":7" />. The 6 types include the following:
The necrotic tissue associated with the MLL is particularly susceptible to infection(2) and if infection occurs, it can lead to
[[File:MRI classification morel lavallee.png|center|thumb|700x700px|De Coninck, T, Vanhoenacker, F and Verstraete, K. Imaging Features of Morel-Lavallée Lesions. Journal of the Belgian Society of Radiology. 2017; 101(S2): 15, pp. 1–8. DOI: <nowiki>https://doi.org/10.5334/jbr-btr.1401</nowiki>]]
 
 
Type I to III are the most common types with Type I being acute, type II, sub-acute and III, chronic<ref name=":6" />.


* Cellulitis (2)
A more basic acute vs chronic classification was proposed by Shen et al (2013)<ref name=":1" />. The lesion is considered chronic once a capsule is present<ref name=":1" />.
* Abscess (2)
* Osteomyelitis (2)
* Necrosis of underlying tissues due to pressure (13)


== Diagnostic Procedures ==
== Diagnostic Procedures ==


add text here relating to diagnostic tests for the condition<br>
add text here relating to diagnostic tests for the condition<br>

Revision as of 10:50, 25 November 2022

Original Editor - Wendy Snyders Top Contributors - Wendy Snyders

Definition[edit | edit source]

A Morel-Lavallée lesion (MLL) was first described in 1853[1] [2]. It is a closed soft-tissue degloving injury[1][3][4][5][6] that usually occurs after blunt trauma[1][2][3][5]. In recent literature, it can also be referred to as  Morel-Lavallée seroma or effusion, post-traumatic soft tissue cysts or post-traumatic extravasations[2].

Epidemiology and aetiology[edit | edit source]

These injuries are uncommon[2] and there is no consensus on the ratio of men to women. One source reported a 2:1 ratio[2] while another reported a 1:1 ratio[7].

These injuries occur due to blunt trauma after:

MLL can also be iatrogenic e.g. after abdominal liposuction or mammoplasty[1][2][6]

Pathophysiology[edit | edit source]

Case courtesy of Dr Matt Skalski, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22762?lang=us">rID: 22762</a>

MLL occurs due to shearing forces which separate the skin and subcutaneous tissue from the deep fascia, causing a potential space[1][2][4][5][8][10][11]. Damage to the lymphatic and blood vessels leads to an accumulation of blood and lymph[1][3][4][8][10] and necrotic fat[1][3][8][12] in the potential space, causing a haematoma or seroma[10]. Blood will start to be reabsorbed over time leaving a serosanguinous fluid surrounded by a haemosiderin layer[2]. Inflammation is then induced by the haemosiderin layer leading to a fibrous capsule[2][11]. This fibrous capsule prevents more fluid reabsorption, initiating a chronic MLL[3].

MLL are often associated with pelvic or acetabular fractures but can also occur without a fracture[9].

Secondary risk factors for an MLL include female gender and BMI of over 25[1].


Clinical Presentation[edit | edit source]

Case courtesy of Dr Matt Skalski, <a href="https://radiopaedia.org/?lang=us">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22762?lang=us">rID: 22762</a>

MLL occurs most commonly over the greater trochanter (>60% of cases)[1][3] [5][6][8][11], proximal femur[1][2][5], buttock[2][3][5], knee[3][5][6][11] and in rare cases, the lumbar region[2][3][6][11]. It can also occur at the scapula[2][6]. Delayed presentation (months or years) can occur in up to ⅓ of patients[1][8]. The most common signs and symptoms include:

  • Compressible, fluctuant swollen area[1][2][5][8][9]. The fluctuant swelling is an essential clinical characteristic[9].
  • Pain[1][2][4][8]
  • Stiffness[5][9]
  • Cutaneous anaesthesia or hypothesia may be present[1][2][4][8]
  • Ecchymosis may be present[9]
  • Abrasions may be present[9]
  • Secondary dermal changes e.g. discolouration, frank necrosis, drying/cracking[1][9]

Complications[edit | edit source]

The necrotic tissue associated with the MLL is particularly susceptible to infection[3] and if infection occurs, it can lead to

  • Cellulitis[3]
  • Abscess[3]
  • Osteomyelitis[3]
  • Necrosis of underlying tissues due to pressure[9]

Classification[edit | edit source]

Mellado and Bencardino proposed a MRI classification and identified 6 types of MLL based on the lesion chronicity, appearance on MRI and tissue composition [2][7][8][9]. The 6 types include the following:

De Coninck, T, Vanhoenacker, F and Verstraete, K. Imaging Features of Morel-Lavallée Lesions. Journal of the Belgian Society of Radiology. 2017; 101(S2): 15, pp. 1–8. DOI: https://doi.org/10.5334/jbr-btr.1401


Type I to III are the most common types with Type I being acute, type II, sub-acute and III, chronic[8].

A more basic acute vs chronic classification was proposed by Shen et al (2013)[2]. The lesion is considered chronic once a capsule is present[2].

Diagnostic Procedures[edit | edit source]

add text here relating to diagnostic tests for the condition

Management / Interventions
[edit | edit source]

add text here relating to management approaches to the condition

Differential Diagnosis
[edit | edit source]

add text here relating to the differential diagnosis of this condition

Resources
[edit | edit source]

add appropriate resources here

References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management. Journal of clinical and diagnostic research: JCDR. 2017 Apr;11(4):TE01.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Singh R, Rymer B, Youssef B, Lim J. The Morel-Lavallée lesion and its management: a review of the literature. Journal of orthopaedics. 2018 Dec 1;15(4):917-21.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Zairi F, Wang Z, Shedid D, Boubez G, Sunna T. Lumbar Morel-Lavallée lesion: case report and review of the literature. Orthopaedics & Traumatology: Surgery & Research. 2016 Jun 1;102(4):525-7.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 LaTulip S, Rao RR, Sielaff A, Theyyunni N, Burkhardt J. Ultrasound utility in the diagnosis of a Morel-Lavallée lesion. Case Reports in Emergency Medicine. 2017 Feb 1;2017.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Depaoli R, Canepari E, Bortolotto C, Ferrozzi G. Morel-Lavallée lesion of the knee in a soccer player. Journal of ultrasound. 2015 Mar;18(1):87-9.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Mettu R, Surath HV, Chayam HR, Surath A. Chronic Morel-Lavallée lesion: a novel minimally invasive method of treatment. Wounds. 2016 Nov 1;28(11):404-7.
  7. ↑ 7.0 7.1 Christian D, Leland HA, Osias W, Eberlin S, Howell L. Delayed presentation of a chronic Morel-Lavallee lesion. Journal of Radiology Case Reports. 2016 Jul;10(7):30.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 De Coninck T, Vanhoenacker F, Verstraete K. Imaging features of Morel-Lavallée lesions. Journal of the Belgian Society of Radiology. 2017;101(Suppl 2).
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 Badjate DM, Jain D, Phansopkar P, Wadhokar OC. A Physical Therapy Rehabilitative Approach in Improving Activities of Daily Living in a Patient With Morel-Lavallée Syndrome: A Case Report. Cureus. 2022 Sep 24;14(9).
  10. ↑ 10.0 10.1 10.2 Weiss NA, Johnson JJ, Anderson SB. Morel-lavallee lesion initially diagnosed as quadriceps contusion: ultrasound, MRI, and importance of early intervention. Western Journal of Emergency Medicine. 2015 May;16(3):438.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Cruz N, Jiménez R. Morel-Lavallée lesion diagnosed 25 years after blunt trauma. International Journal of Surgery Case Reports. 2021 Apr 1;81:105733.
  12. ↑ Cochran GK, Hanna KH. Morel-Lavallee lesion in the upper extremity. Hand. 2017 Jan;12(1):NP10-3.
Retrieved from "https://www.physio-pedia.com/index.php?title=Morel-Lavallée_lesion&oldid=321517"