Thoracolumbar Morel-Lavallée Lesion as an Unusual Source of Post-Traumatic Anemia: A Case Report and Literature Review

Öz

Introduction: Morel-Lavallée lesions are rare closed degloving injuries resulting from traumatic shear forces that separate the subcutaneous tissue from the underlying fascia. Although they most frequently occur in the pelvis and thigh, thoracolumbar involvement is exceedingly uncommon and may be underrecognized in trauma settings, leading to delays in diagnosis. Case Report: A 22-year-old man was admitted following a motor-vehicle accident with left-sided pulmonary contusion and pneumothorax and was managed conservatively. On the second day of hospitalization, his hemoglobin level abruptly fell to 5 g/dL despite stable daily thoracic imaging. Subsequent cross-sectional studies revealed a 25-cm hematoma extending from the thoracolumbar region into the left gluteal and lateral thigh compartments, consistent with a Morel-Lavallée lesion. The patient was managed conservatively with compression and transfusion of four units of erythrocyte suspension, resulting in clinical stabilization and full recovery. Conclusion: Thoracolumbar Morel-Lavallée lesions are rare but may lead to substantial concealed blood loss. They should be considered in trauma patients presenting with unexplained anemia. Early imaging—CT for rapid assessment and MRI for definitive characterization—supports timely diagnosis, and carefully selected patients may achieve complete recovery with vigilant conservative management.

Anahtar Kelimeler

• Hematoma
• Blood Transfusion
• Morel-Lavallée lesion
• Thoracolumbar Region
• Case Reports

Torakolomber Morel-Lavallée Lezyonu: Travma Sonrası Açıklanamayan Aneminin Nadir Bir Nedeni ve Literatür Derlemesi

Öz

Giriş: Morel-Lavallée lezyonları, travmatik kayma kuvvetlerinin deri altı dokuyu alttaki fasyadan ayırması sonucu gelişen nadir kapalı degloving yaralanmalarıdır. En sık pelvis ve uyluk bölgesinde görülmekle birlikte, torakolomber yerleşim son derece nadirdir ve travma ortamında sıklıkla gözden kaçabildiğinden tanıda gecikmelere yol açabilir Olgu Sunumu: Yirmi iki yaşındaki erkek hasta, araç içi trafik kazası sonrası sol akciğer kontüzyonu ve pnömotoraks nedeniyle kliniğimize kabul edildi ve konservatif olarak tedavi edildi. Hastaneye yatışının ikinci gününde, günlük akciğer grafilerinde stabil görünüm olmasına rağmen hemoglobin düzeyi ani şekilde 5 g/dL’ye düştü. Yapılan kesitsel görüntülemelerde, torakolomber bölgeden başlayıp sol gluteal bölge ve uyluk laterali boyunca uzanan 25 cm’lik hematom Morel-Lavallée lezyonu ile uyumlu bulundu. Hastaya kompresyon tedavisi ve dört ünite eritrosit süspansiyonu replasmanı uygulandı; klinik olarak stabilize olan hasta tamamen iyileşti. Sonuç: Torakolomber yerleşimli Morel-Lavallée lezyonları nadir görülmekle birlikte belirgin gizli kan kaybına neden olabilir ve açıklanamayan anemi ile başvuran travma hastalarında mutlaka akılda tutulmalıdır. Hızlı değerlendirme için BT ve kesinleştirme için MRG ile erken görüntüleme tanıyı kolaylaştırır. Uygun seçilmiş hastalarda dikkatli konservatif yaklaşım ile tam iyileşme sağlanabilir.

Anahtar Kelimeler

• Hematom
• Kan Transfüzyonu
• Morel-Lavallée Lezyonu
• Torakolomber Bölge
• Olgu Sunumu

Kaynakça

1. 1. Yang Y, Tang TT. The Morel-Lavallée lesion: review and update on diagnosis and management. Orthop Surg. 2023;15(10):2485-2491. Doi:10.1111/os.13826
2. 2. Shim KD, Choi WR, Park YS. Extensive multiple Morel-Lavallée lesions: a case report. J Korean Fract Soc. 2017;30(3):142-145.
3. 3. Mulcahy MJ, Ball JR. The Morel-Lavallée lesion in thoracolumbar spine trauma: two index cases. J Spine Surg. 2018;4(3):654-657. doi:10.21037/jss.2018.06.20
4. 4. Scolaro JA, Chao T, Zamorano DP. The Morel-Lavallée lesion: diagnosis and management. J Am Acad Orthop Surg. 2016;24(10):667-672. doi:10.5435/JAAOS-D-15-00181
5. 5. Buyukkaya A, Gunes H, Ozel MA, Buyukkaya R, Onbas O, Saritas A. Lumbar Morel-Lavallée lesion after trauma: report of two cases. Am J Emerg Med. 2015;33(8):1116.e5-1116.e6. doi:10.1016/j.ajem.2015.01.043
6. 6. Pothiawala S, Miranda R, Tsai YJJ, Civil I. Morel-Lavallée lesion: an uncommon internal degloving injury in trauma patients. Trauma. 2023;25(4):282-291. doi:10.1177/14604086231166174
7. 7. Claassen L, Franssen MA, de Loos ER. A rare case of hemorrhagic shock: Morel-Lavallée lesion. Clin Pract Cases Emerg Med. 2019;3(4):417-420. doi:10.5811/cpcem.2019.9.43674
8. 8. Molina BJ, Ghazoul EN, Janis JE. Practical review of the comprehensive management of Morel-Lavallée lesions. Plast Reconstr Surg Glob Open. 2021;9(10):e3850. doi:10.1097/GOX.0000000000003850

9. 9. Falconi A, Crellin H, Tagawa C. A rare presentation of a Morel-Lavallée lesion of the lower leg successfully treated with ultrasound-guided aspiration. Clin J Sport Med. 2018;28(4):e87-e88. doi:10.1097/JSM.0000000000000455
10. 10. Lougher L, Hughes A, Joseph V, Roy K. Cervico-thoracic Morel-Lavallée lesion. BMJ Case Rep. 2023;16(11):e253510. doi:10.1136/bcr-2022-253510
11. 11. Vagholkar K. Morel-Lavallée lesion: uncommon injury often missed. J Orthop Case Rep. 2022;12(10):57-60. doi:10.13107/jocr.2022.v12.i10.3366
12. 12. Nicolas G, Abbas L, Prado A, Takemura RE, Wada A, Souza Gomez D, et al. Stage VI Morel-Lavallée lesion with a large challenging defect. Plast Reconstr Surg Glob Open. 2021;9(4):e3502. doi:10.1097/GOX.0000000000003502
13. 13. De Coninck T, Vanhoenacker F, Verstraete K. Imaging features of Morel-Lavallée lesions. J Belg Soc Radiol. 2017;101(Suppl 2):15. doi:10.5334/jbr-btr.1401
14. 14. Barrera JE, Wei S, Obinero CG, Tang C, Cao E, Osamor C, et al. Is more better? Evaluating the impact of early surgical debridement on Morel-Lavallée lesions. Am J Surg. 2025;244:116238. doi:10.1016/j.amjsurg.2025.116238
15. 15. Li X, Li R, Luo X, Chen T, Wu J. Giant Morel-Lavallée lesion complicated with open pelvic fracture: a rare case report. Front Surg. 2025;12:1639073. doi:10.3389/fsurg.2025.1639073
16. 16. Liu M, Liu L, Zhou X, Wu L, Wang J, Qi L, et al. Endoscopic debridement combined with percutaneous cutaneo-fascial suture for Morel-Lavallée lesion. Injury. 2018;49(8):1630-1633. doi:10.1016/j.injury.2018.06.003
17. 17. Li P, Ning X, Jia L, Du G, Jiang S, Gong Z, et al. A minimally invasive incision and loop drainage technique for lower limb Morel-Lavallée lesions. Injury. 2020;51(2):570-573. doi:10.1016/j.injury.2019.12.014
18. 18. Singh R, Rymer B, Youssef B, Lim J. The Morel-Lavallée lesion and its management: a review of the literature. J Orthop. 2018;15(4):917-921. doi:10.1016/j.jor.2018.08.032