Olgu Sunumu
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Morel-Lavallée Lesion of the Knee: A Case Report

Yıl 2025, Cilt: 47 Sayı: 5, 844 - 849, 04.09.2025
https://doi.org/10.20515/otd.1638187

Öz

Morel-Lavallée lesions are closed soft tissue injuries caused by a shearing force that separates the skin and superficial fascia from the deep fascia, creating a potential space where hemolymphatic fluid accumulates. These lesions are often misdiagnosed due to their variable clinical presentation and heterogeneous morphology, which can lead to confusion with conditions such as hematoma, fat necrosis, and sarcoma. The typical localization of the lesion is the trochanteric region. This case report presents the clinical and radiological findings, along with the diagnosis and treatment process, of a 56-year-old female patient who developed a Morel-Lavallée lesion in the prepatellar region following a fall. In the first stage, no bone abnormality was seen in computed tomography (CT) imaging. Magnetic resonance imaging (MRI) and ultrasonography (USG) performed as a result of her ongoing complaints revealed a well-defined fluid accumulation in the prepatellar region, consistent with a Morel Lavallée lesion. Clinical examination and patient history are essential for diagnosis. However, MRI and USG play an important role in confirming the diagnosis and monitoring the course of the disease. A classification has been proposed for Morel-Lavallée lesions, which are divided into six subtypes based on MRI features. USG is particularly practical and useful modality both for initial diagnosis and follow-up evaluation. Some lesions may resolve spontaneously. If not recognized and treated appropriately, they may become chronic or complicated, requiring more invasive interventions. Recognizing the lesion’s characteristics and implementing a personalized treatment strategy are essential for achieving optimal patient outcomes.

Etik Beyan

Ethical approval was not required for this study in accordance with local/national guidelines.

Kaynakça

  • 1. Morel-Lavallée M. Decollements traumatiques de la peau et des couches sousjacentes. Arch Gen Med 1863;1:20–38, 172–200, 300–332.
  • 2. Bonilla-Yoon I, Masih S, Patel DB, White EA, Levine BD, Chow K, et al. The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 2014;21:35-43.
  • 3. Khodaee M, Deu RS., Mathern S, Bravman JT. Morel-Lavallée lesion in sports. Curr Sports Med Rep 2016;15(6):417-22.
  • 4. Zecha PJ, Missotten FE. Pseudocyst formation after abdominoplasty–extravasations of Morel-Lavallée. Br J Plast Surg 1999;52(6):500-502.
  • 5. Mettu R, Surath HV, Chayam HR, Surath A. Chronic Morel-Lavallée lesion: a novel minimally invasive method of treatment. Wounds 2016;28(11):404-7.
  • 6. Zairi F, Wang Z, Shedid D, Boubez G, Sunna T. Lumbar Morel-Lavallée lesion: case report and review of the literature. Orthop Traumatol Surg Res 2016;102(4):525-7.
  • 7. Zhong B, Zhang C, Luo CF. Percutaneous drainage of Morel-Lavallée lesions when the diagnosis is delayed. Can J Surg 2014;57(5):356.
  • 8. Yang Y, Tang TT. The Morel‐Lavallée Lesion: Review and Update on Diagnosis and Management. Orthop Surg 2023;15(10):2485-91.
  • 9. Volavc TS, Rupreht M. MRI of the Morel-Lavallée lesion–a case series. Radiol Oncol 2021;55(3):268-73.
  • 10. Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med 2007;35(7):1162–7.
  • 11. Borrero CG, Maxwell N, Kavanagh E. MRI findings of prepatellar Morel-Lavallée effusions. Skeletal Radiol 2008;37(5):451-5.
  • 12. Mellado JM, Bencardino JT. Morel-Lavallée lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin N Am 2005;13(4):775-82.
  • 13. De Coninck T, Vanhoenacker F, Verstraete K. Imaging features of Morel-Lavallée lesions. J Belg Soc Radiol 2017;101(Suppl 2):15.
  • 14. Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management. J Clin Diagn Res 2017;11(4):1-4.
  • 15. McKenzie GA, Niederhauser BD, Collins MS, Howe BM. CT characteristics of Morel-Lavallée lesions: an under-recognized but significant finding in acute trauma imaging. Skeletal Radiol 2016;45:1053-60.
  • 16. Neal C, Jacobson JA, Brandon C, Kalume‐Brigido M, Morag Y, Girish G. Sonography of Morel‐Lavallée Lesions. J Ultrasound Med 2008;27(7):1077-81.
  • 17. Fornecker C, Griffon C, Knauer V, Stephan D. Morel-Lavallée syndrome, an unusual differential diagnosis for deep vein thrombosis. J Mal Vasc 2006;31(2):98-100.
  • 18. Kalacı A, Karazincir S, Yanat AN. Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm. Clin Imaging 2007;31(4):287-91.
  • 19. Liu PT, Leslie KO, Beauchamp CP, Cherian SF. Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI. Skeletal Radiol 2006;35:254-7.
  • 20. Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS. The morel‐lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop 2012;2012(1):593193.
  • 21. Teng VSY, Sia SY, Zhang J, Gartner LE, Unnikrishnan K, Puhaindran ME, et al. Morel-lavallee lesion of the right thigh mimicking sarcoma. Am J Phys Med Rehabil 2019;98(5):52-3.
  • 22. Stiff KM, Vargas C, Bates M, Somach SC. Chronic Morel-Lavallée lesion: Presentation as a pseudotumor. JAAD Case Rep 2022;27:75-8.
  • 23. Heifner JJ, Small TM, Fox YM, Ogg R, Corces A. Recurrence of symptoms may indicate the presence of a Morel-Lavallée lesion of the knee: A case report and literature review. Trauma Case Rep 2023;46:100842.
  • 24. Penaud A, Quignon R, Danin A, Bahé L, Zakine G. Alcohol sclerodhesis: an innovative treatment for chronic Morel-Lavallée lesions. J Plast Reconstr Aesthet Surg 2011;64(10):262–4.
  • 25. Luria S, Applbaum Y, Weil Y, Liebergall M, Peyser A. Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts): case report of 4 patients. J Orthop Trauma 2006;20(6):435–8.
  • 26. Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline. J Trauma Acute Care Surg 2014;76(2):493-7.
  • 27. Liu M, Liu L, Zhou X, Wu L, Wang J, Qi L, et al. A novel surgical technique for treatment of Morel-Lavallée lesion: endoscopic debridement combined with percutaneous cutaneo-fascial suture. Injury 2018;49(8):1630–3.
  • 28. Li P, Ning X, Jia L, Du G, Jiang S, Gong Z, Song K, Wang Z, Zhang K. A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: Nose ring drainage technique. Injury 2020;51(2):570-3.

Dizde Morel-Lavallée Lezyonu: Olgu Sunumu

Yıl 2025, Cilt: 47 Sayı: 5, 844 - 849, 04.09.2025
https://doi.org/10.20515/otd.1638187

Öz

Morel-Lavallée lezyonları, deri ve yüzeysel fasya ile derin fasyayı ayıran ve hemolenfatik sıvının biriktiği potansiyel bir boşluk yaratan bir kesme kuvvetinin neden olduğu kapalı yumuşak doku yaralanmalarıdır. Bu lezyonlar, değişken klinik sunumları ve hematom, yağ nekrozu ve sarkom gibi durumlarla karıştırılmasına yol açabilen heterojen morfolojileri nedeniyle sıklıkla yanlış teşhis edilir. Lezyonun tipik lokalizasyonu trokanterik bölgedir. Bu olgu sunumunda ise, düşme sonrası prepatellar bölgede Morel-Lavallée lezyonu gelişen 56 yaşında bir kadın hastanın klinik ve radyolojik bulguları ile beraber tanı ve tedavi süreci sunulmaktadır. İlk aşamada, bilgisayarlı tomografi (BT) görüntülemesinde kemik anormalliği görülmemiştir. Devam eden şikayetleri sonucunda yapılan manyetik rezonans görüntüleme (MRG) ve ultrasonografi (USG), Morel Lavallée lezyonuyla uyumlu, prepatellar bölgede iyi tanımlanmış bir sıvı birikimi ortaya koymuştur. Tanı için klinik muayene ve hastanın öyküsü esastır. Ancak tanıyı doğrulamak ve hastalığın seyrini izlemek için MR ve USG önemli rol oynar. Morel Lavallée lezyonları için MRI özelliklerine dayanan altı alt tipe ayrıldığı bir sınıflandırma önerilmiştir. USG de hem ilk tanı aşamasında hem de takip değerlendirmesi için oldukça pratik ve kullanışlı bir yöntemdir. Bazı lezyonlar kendiliğinden çözülebilir. Uygun şekilde tanınmaz ve tedavi edilmezse kronikleşebilir veya komplike hale gelebilir ve daha invaziv müdahaleler gerektirebilir. Lezyonun özelliklerini tanımak ve kişiselleştirilmiş bir tedavi stratejisi uygulamak, optimum hasta sonuçlarına ulaşmak için esastır.

Kaynakça

  • 1. Morel-Lavallée M. Decollements traumatiques de la peau et des couches sousjacentes. Arch Gen Med 1863;1:20–38, 172–200, 300–332.
  • 2. Bonilla-Yoon I, Masih S, Patel DB, White EA, Levine BD, Chow K, et al. The Morel-Lavallée lesion: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 2014;21:35-43.
  • 3. Khodaee M, Deu RS., Mathern S, Bravman JT. Morel-Lavallée lesion in sports. Curr Sports Med Rep 2016;15(6):417-22.
  • 4. Zecha PJ, Missotten FE. Pseudocyst formation after abdominoplasty–extravasations of Morel-Lavallée. Br J Plast Surg 1999;52(6):500-502.
  • 5. Mettu R, Surath HV, Chayam HR, Surath A. Chronic Morel-Lavallée lesion: a novel minimally invasive method of treatment. Wounds 2016;28(11):404-7.
  • 6. Zairi F, Wang Z, Shedid D, Boubez G, Sunna T. Lumbar Morel-Lavallée lesion: case report and review of the literature. Orthop Traumatol Surg Res 2016;102(4):525-7.
  • 7. Zhong B, Zhang C, Luo CF. Percutaneous drainage of Morel-Lavallée lesions when the diagnosis is delayed. Can J Surg 2014;57(5):356.
  • 8. Yang Y, Tang TT. The Morel‐Lavallée Lesion: Review and Update on Diagnosis and Management. Orthop Surg 2023;15(10):2485-91.
  • 9. Volavc TS, Rupreht M. MRI of the Morel-Lavallée lesion–a case series. Radiol Oncol 2021;55(3):268-73.
  • 10. Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med 2007;35(7):1162–7.
  • 11. Borrero CG, Maxwell N, Kavanagh E. MRI findings of prepatellar Morel-Lavallée effusions. Skeletal Radiol 2008;37(5):451-5.
  • 12. Mellado JM, Bencardino JT. Morel-Lavallée lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin N Am 2005;13(4):775-82.
  • 13. De Coninck T, Vanhoenacker F, Verstraete K. Imaging features of Morel-Lavallée lesions. J Belg Soc Radiol 2017;101(Suppl 2):15.
  • 14. Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management. J Clin Diagn Res 2017;11(4):1-4.
  • 15. McKenzie GA, Niederhauser BD, Collins MS, Howe BM. CT characteristics of Morel-Lavallée lesions: an under-recognized but significant finding in acute trauma imaging. Skeletal Radiol 2016;45:1053-60.
  • 16. Neal C, Jacobson JA, Brandon C, Kalume‐Brigido M, Morag Y, Girish G. Sonography of Morel‐Lavallée Lesions. J Ultrasound Med 2008;27(7):1077-81.
  • 17. Fornecker C, Griffon C, Knauer V, Stephan D. Morel-Lavallée syndrome, an unusual differential diagnosis for deep vein thrombosis. J Mal Vasc 2006;31(2):98-100.
  • 18. Kalacı A, Karazincir S, Yanat AN. Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm. Clin Imaging 2007;31(4):287-91.
  • 19. Liu PT, Leslie KO, Beauchamp CP, Cherian SF. Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI. Skeletal Radiol 2006;35:254-7.
  • 20. Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS. The morel‐lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop 2012;2012(1):593193.
  • 21. Teng VSY, Sia SY, Zhang J, Gartner LE, Unnikrishnan K, Puhaindran ME, et al. Morel-lavallee lesion of the right thigh mimicking sarcoma. Am J Phys Med Rehabil 2019;98(5):52-3.
  • 22. Stiff KM, Vargas C, Bates M, Somach SC. Chronic Morel-Lavallée lesion: Presentation as a pseudotumor. JAAD Case Rep 2022;27:75-8.
  • 23. Heifner JJ, Small TM, Fox YM, Ogg R, Corces A. Recurrence of symptoms may indicate the presence of a Morel-Lavallée lesion of the knee: A case report and literature review. Trauma Case Rep 2023;46:100842.
  • 24. Penaud A, Quignon R, Danin A, Bahé L, Zakine G. Alcohol sclerodhesis: an innovative treatment for chronic Morel-Lavallée lesions. J Plast Reconstr Aesthet Surg 2011;64(10):262–4.
  • 25. Luria S, Applbaum Y, Weil Y, Liebergall M, Peyser A. Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts): case report of 4 patients. J Orthop Trauma 2006;20(6):435–8.
  • 26. Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline. J Trauma Acute Care Surg 2014;76(2):493-7.
  • 27. Liu M, Liu L, Zhou X, Wu L, Wang J, Qi L, et al. A novel surgical technique for treatment of Morel-Lavallée lesion: endoscopic debridement combined with percutaneous cutaneo-fascial suture. Injury 2018;49(8):1630–3.
  • 28. Li P, Ning X, Jia L, Du G, Jiang S, Gong Z, Song K, Wang Z, Zhang K. A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: Nose ring drainage technique. Injury 2020;51(2):570-3.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Fiziksel Tıp ve Rehabilitasyon
Bölüm OLGU SUNUMLARI / CASE REPORTS
Yazarlar

Gizem Sarıçimen 0000-0002-7645-7790

Cüneyt Çalışır Bu kişi benim 0009-0006-8800-8032

Yayımlanma Tarihi 4 Eylül 2025
Gönderilme Tarihi 14 Şubat 2025
Kabul Tarihi 29 Nisan 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 5

Kaynak Göster

Vancouver Sarıçimen G, Çalışır C. Morel-Lavallée Lesion of the Knee: A Case Report. Osmangazi Tıp Dergisi. 2025;47(5):844-9.


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