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Age / Sex : /
Age / Sex : 30/M
Chief complaint : Swelling of the Rt. Lateral hip, 5 month after the skateboard-associated trauma
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected])
Courtesy : Choon-Sik Yoon, MD., Yongdong Severance Hospital
Diagnosis: abscess superimposed in hematoma of Morel-Lavallee lesion
Discussion
Findings:
A space occupying lesion is noted at deep subcutaneous tissue just adjacent to the right iliotibial tract. The lesion shows fluid signal. Just rim enhancement is seen in gadolinium enhancement around the lesion. Adjacent subcutaneous fat shows salient edema or inflammation.
Differential Diagnosis:
No differential diagnosis except acute Morel Lavallee lesion.
Diagnosis: Abscess superimposed in the hematoma of Morel-Lavallee lesion.
Discussion:
Morel-Lavallee lesions are posttraumatic fluid collections that dissect deep to and along subcutaneous fatty tissue planes (the perifascial plane adjacent to the tensor fascia lata and the iliotibial band) in the area of the trochanteric region and proximal thigh. More-Lavalle effusions are usually associated with tangential trauma, as seen in high-speed motor vehicle accidents. Hemorrhage that dissects the superficial and deep fascia is also referred to as a degloving lesion. In the thigh the superficial fascia is also the deepest portion of the subcutaneous tissue, and the fascia lata, or deep fascia, covers the outer surface of the thigh muscles. Distally the fascia lata is reinforced as the iliotibial band. The frequency of Morel-Lavallee lesions in the trochanteric area and proximal thigh may be related to the firm attachment of the anterolateral fascia lata and iliotibial band and the secondary mobility and thus susceptibility of the regional skin dermis, including the perforating vessels of the deep fascia. This lesion have been subgrouped into following types:
Type I, a fluid-like serohematic effusion;
Type II, a subacute hematoma;
Type III, a chronic organizing hematoma;
Type IV, perifascial dissection and a closed fatty tissue laceration;
Type V, a perifascial pseudonodular lesion;
Type VI, infection with or without thick capsular septation and a sinus tract.
If particularly subgrouped, the demonstrated case was type VI.
References:
Stoller DW, Sampson T, and Bredella M. Chatper 3. The hip. In: Stoller DW eds. Magnetic Resonance Imaging in Orthopedics and Sports Medicine, 3rd ed. Philadelphia, Pensylvania: Lippincott Williams & Wilkins, 2007: 159.
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