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Age / Sex : 58 / M
Chief complaint : swelling
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).
Courtesy : 박선영, Sun-Young Park, 한림대학교성심병원, Hallym Sacred Heart Hospital
Diagnosis: Morel-lavallee lesion
Discussion
Imaging findings
MRI
- About 2.7 cm loculated fluid at anterior aspect of distal tibia subcutaneous layer, superficial to deep fascia.
-- containing a lobule of internal fat signal intensity (Arrow)
-- showing peripheral capsular enhancement.
US
- About 6.9 extent loculated fluid collection with internal septation at right lower leg anterior aspect, deep subcutaneous layer along the fascial plane
Morel-lavallee lesion
- Post-traumatic soft tissue degloving injury
- Results from direct or tangential shearing forces that separate the skin and subcutaneous tissue from the underlying fascia
- These shearing forces can disrupt perforating vessels and nerves, creating a potential space that fills with blood, lymph, debri, and fat.
- Typically oval, fusiform, or crescentic, consistent with fluid dissecting along traumatized fascial planes
- MRI imaging characteristics : the concentration of hemolymphatic fluid, the chronicity of the blood-by-products, the presence of fat (viable or necrotic), the presence or absence of a capsule, and varying degrees of enhancement.
References
- Mallado JM, Bencardino JT. Morel-Lavallee Lesion: Review with Emphasis on MR Imaging. Magn Reson Imaging Clin N Am. 2005; 13: 775-782.
- Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee Lesion of the Knee Twenty-Seven Cases in the National Football League. The American Journal of Sports Medicine. 2007; 35:1162-1167.
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