MR imaging characteristics of Morel-Lavallee lesions in pediatric patients

Yıl 2022, Cilt: 5 Sayı: 3, 702 - 705, 30.05.2022

Ömer Kazcı , Düzgün Can Şenbil , Seda Kaynak Şahap , Berna Ucan , Sonay Aydın

https://doi.org/10.32322/jhsm.1074217

Öz

Aim: Morel-Lavallée syndrome (MLS) is a serious posttraumatic soft tissue injury in which the subcutaneous tissues are separated from the underlying fascia by glove-finger (closed type) peeling and replaced by a cavity filled with hematoma and fat. It is most commonly seen in the trochanter major, but it can also be found in the flank, hip, and lumbodorsal regions. The goal of this study is to define the typical findings of MLS in order to avoid misdiagnosis and delay in patient treatment.
Material and Method: This retrospective study was approved by the Institutional Review Board. Informed consent was waived due to the retrospective nature of the study. Between 2015 and 2021, MR images and clinical follow-ups of 22 pediatric patients with clinical and radiological Morel-Lavallée lesions (MLL) were reviewed retrospectively. All patients were evaluated using 1.5T or 3T power MR devices (Siemens Healthineers, Erlangen, Germany).
Results: Of 22 patients diagnosed with MLS, 77% (n=17) were male and 23% (n=5) were female. Patients ranged in age from 7 to 18 years, with a mean of 13.2 years (+/-2,3). The locations of MLL were knee (77%, n=17, 15 patients had anterior knee and 2 patients had posterior knee involvement), hip (14%, n=3) and thigh (9%, n=2) in order of frequency. These lesions all had a similar ovoid shape. The majority of patients (18/22) received solely conservative management but three patients underwent percutaneous drainage.
Conclusion: In our study, the importance of differential diagnosis of MLL from traumatic collections and the importance of MRI findings in diagnosis and treatment were discussed. Accurate diagnosis and treatment of MLL are critical, as the lesion's size may increase as a result of delayed treatment, causing skin necrosis and denervation due to the mass effect.

Anahtar Kelimeler

morellavalle, MRİ, traumaticcollection

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

• Gummalla KM, George M, Dutta R. Morel-Lavallee lesion: case report of a rare extensive degloving soft tissue injury. Ulus Travma Acil Cerrahi Derg 2014: 63-5.
• Bonilla-Yoon I, Masih S, Patel DB, et al. The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 2014: 35-43.
• McKenzie GA, Niederhauser BD, Collins MS, Howe BMJSr. CT characteristics of Morel-Lavallée lesions: an under-recognized but significant finding in acute trauma imaging. Skeletal Radiol 2016: 1053-60.
• Cheong SCW, Wong BSSJSmj. Clinics in diagnostic imaging . Morel-Lavallée lesion. Singapore Med J 2016: 45.
• Mellado JM, Bencardino JTJMRIC. Morel-Lavallée lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin 2005: 775-82.
• Shelley J, Noritake A, Ortiz K, Ricca R. Morel-Lavallee lesion in pediatric trauma. Pediatr Surg Int 2017: 921-4.
• Rapp JB, Barrera CA, Ho-Fung VMJPR. Morel-Lavellée lesions: MRI characteristics in the pediatric patient. Pediatr Radiol 2019: 559-65.
• Rha EY, Kim DH, Kwon H, Jung SN. Morel-lavallee lesion in children. World J Emerg Surg 2013: 60.
• van Gennip S, van Bokhoven SC, van den Eede EJCJoSM. Pain at the knee: the Morel-Lavallée lesion, a case series. Clin J Sport Med 2012: 163-6.
• Parra J, Fernandez M, Encinas B, Rico MJSr. Morel-Lavallée effusions in the thigh. Skeletal Radiol 1997: 239-41.
• Mukherjee K, Perrin SM, Hughes PM. Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation. Skeletal Radiol 2007: 43-5.
• Moriarty J, Borrero C, Kavanagh EJIjoms. A rare cause of calf swelling: the Morel-Lavallee lesion. Irish J Med Sci 2011: 265-8.
• Zecha P, Missotten FJBjops. Pseudocyst formation after abdominoplasty-extravasations of Morel-Lavallée. Br J Plast Surg 1999: 500-2.
• Anakwenze OA, Trivedi V, Goodman AM, Ganley TJJJ. Concealed degloving injury (the Morel-Lavallée lesion) in childhood sports: a case report. JBJS 2011: 148.
• Moran DE, Napier NA, Kavanagh EC. Lumbar Morel-Lavallée effusion 2012.
• Scaranelo AM, Davanço RAJBjops. Pseudocyst formation after abdominal liposuction—extravasations of Morel-Lavallée on MR images. Br J Plast Surg 2005: 849-51.
• Yilmaz A, Yener O. Giant post-traumatic cyst after motorcycle injury: a case report with review of the pathogenesis. Prague Med Rep 2013; 114: 123-7.