A Rare Cause of Septic Shock Secondary to Trauma: Morel Lavallée Lesion - Case Report

Introduction Morel Lavallée lesion is a hemolymphatic collection in between muscular fascia that can be caused by the separation of soft tissue and muscular fascia in degloving fashion. Morel Lavallée lesion is an infrequent lesion but should be known for medico-legal reports Morel Lavallée is a rare presentation that can cause life-threatening septic and hemorrhagic shock. Case PresentationIn this case report we are going present Morel Lavallée lesion which can present with septic shock and bleeding and can be mortal. Our patient, fourty seven years old male, arrived at the emergency department with an ambulance 1 hour after an extravehicular traffic accident. Apart from a right hemopneumothorax with multiple rib fractures, grade 2 laceration in spleen and bilateral kidneys, zone 2 fracture of sacrum, computer tomography (CT) revealed a closed, degloving injury of the pelvis , also known as a Morel-Lavallée lesion. On CT, Morel Lavallée lesion appear as well-defined, encapsulated fluid collections that occasionally show fluid fluid levels .. Heavy fluid collection was detected in control CT which was actually a collection infected hematoma in the operative setting. Patient was diagnosed in the first 12 hours and necrotic tissues were debrided. Patient was considered deceased after 15 days without any improvement in his GCS score.ConclusionsThere is one report that describe mortality after Morel Lavallée lesion in the autopsy setting. Early diagnosis and treatment are essential to decrease severity of necrosis and sepsis though our patient has deceased due to complications of sepsis

Huge scalp Morel-Lavallée lesion with eye involvement in a 3-year-old girl: a case report

Background Morel-Lavallée lesions are posttraumatic, closed degloving injuries in which the skin and subcutaneous tissue are separated abruptly from superficial underlying fascia. This condition leads to an effusion containing hemolymph and necrotic fat. Magnetic resonance imaging, when available, is the modality of choice in the evaluation of Morel-Lavallée lesion. Early diagnosis and management is essential as any delay in diagnosis or missed lesion will lead to the effusion becoming infected or leading to extensive skin necrosis. We present a condition of a Morel-Lavallée lesion involving the scalp and complicated by conjunctival chemosis. Case presentation We report on a 3-year-old black African girl who presented a fluctuant swelling of entire scalp, extending to upper part of the face on the seventh day after a forehead trauma due to falling on a rock while playing. Skull x-ray revealed soft-tissue swelling, giving an impression of large fluid collection in the deep subcutaneous tissues with no bone fracture. A diagnosis of Morel-Lavallée lesion of the scalp complicated by conjunctival chemosis was made. The patient was managed with percutaneous drainage and compression bandage. The patient improved well and was subsequently discharged without any vision impairment. There was no recurrence of the lesion on follow-up. Conclusions The Morel-Lavallée lesion of the scalp complicated with conjunctival chemosis is a rare presentation of this condition. Prompt diagnosis and management are crucial for preventing complications. Image-guided diagnosis and treatment still remain a challenge in the setting of low-resource health facilities.

Identification and triage of a Morel-Lavallée lesion using point of care ultrasound

Introduction A Morel-Lavallée lesion is a relatively rare, closed, degloving injury. Polytrauma and severe injuries through to seemingly innocuous trauma can distract the clinician from thorough assessment of the affected site. Missed or misdiagnosis of the closed lesion is reported from both a clinical and imaging perspective. Case report A 46-year-old male is discharged from accident and emergency with a shoulder injury following a cycling accident. Ten days post trauma, an advanced practice physiotherapist suspects a lateral thigh Morel-Lavallée lesion during a telephone assessment (Covid-19 restrictions). A face to face appointment with imaging the following day confirmed the suspicion. Discussion The aetiology, imaging and clinical management of a Morel-Lavallée lesion is discussed. The addition of diagnostic ultrasound skills to clinical assessment in this case report may have improved patient care and experience by offering a ‘one stop shop’ to care. Formal training in musculoskeletal ultrasound imaging is emphasised. Conclusion Thorough history taking, clinical reasoning and subsequent application of robust imaging led to the identification of a Morel-Lavellée lesion and, in this case, highlights the value of a point of care ultrasound model in a triage setting.

Understanding the “Empty Toe” Phenomenon: A Rare Case Report

Closed degloving injury involving a toe represents a rare phenomenon in which the bones of the toe dislocate but the soft-tissue envelope remains intact. It has been described sparingly throughout the medical literature, and outcomes have been poor. This article presents a case report of the unique injury while also investigating trends through a detailed review of the literature.

Retrosacral Morel-Lavallée lesion: resolution with ultrasound-guided drainage and sclerotherapy

Morel-Lavallée lesions are chronic seromas due to closed degloving injuries, resulting from blunt trauma. They most commonly occur over the greater trochanteric, gluteal and flank regions. We present a case of retrosacral Morel-Lavallée lesion. Initial ultrasound demonstrated a fluid collection lying between the subcutaneous fat and the underlying fascia superficial to the sacrum. Following repeated ultrasound-guided aspirations, further recurrence of a superficial pre-sacral seroma was confirmed with MRI. Ultrasound-guided aspiration was performed and 100 mg of injectable doxycycline was instilled into the lesion. 4 months after sclerotherapy, the patient was asymptomatic, and follow-up MRI demonstrated no residual fluid collection or complication. This case demonstrates the value of using MRI in conjunction with ultrasound to characterize Morel-Lavallée lesions in an atypical site and in confirming response to treatment, in addition to the use of sclerotherapy for treatment of a lesion refractory to repeated aspiration.

Nontraumatic Anterior Thigh Pain in a NCAA Lacrosse Athlete: A Case Report and Description of a Rectus Femoris Degloving Injury

A 21-year-old female lacrosse player complained of anterior thigh pain with no known mechanism of injury and failed to improve with conservative therapy. An MRI was obtained showing a closed degloving injury of the rectus femoris, an injury only previously reported in a small case series of soccer players. After a brief period of rest, she was progressed conservatively through therapy and did well, with progression back to the level of competition at 56 days. This case highlights a rare injury not previously described in sports outside of soccer and is the first case described in a female athlete. In addition, the discussion of this case focuses on the unique anatomy of the rectus femoris.

Morel-Lavallée lesion in a ‘non-traumatic’ thigh: a diagnostic challenge!

Background: Morel-Lavallée Lesion (MLL) or Morel-Lavallée Seroma (MLS) is a posttraumatic seroma that occurs following a closed degloving injury. It is very important for trauma surgeons to be aware of this relatively rarely reported entity as early diagnosis increases the likelihood of successful management. Case report: We present a patient, wherein the patient had no history of trivial trauma and presented with a gradually growing swelling of left thigh, that was clinically and radiologically diagnosed as a soft tissue neoplasm, successfully managed by surgical excision and were reported to be a MLS. The clinical diagnostic dilemma was solved by the histopathologist! Conclusion: A differential diagnosis of MLL should be kept in mind in patients presenting with soft tissue swellings. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.145-148

MOREL-LAVALLEE LESION (MLL): case report and literature review on diagnosis and management of post-traumatic MLL in patients with polytrauma

Morel-Lavallee lesion has become an eponym since Maurice Morel-Lavallee described the first closed degloving injury in 1853. In present days, Morel-Lavallee lesion is still a rare condition resulting from blunt shearing of soft tissues due to trauma that separates the hypodermis from underlying fascia. The cavity that is created between the separated skin with subcutaneous tissue and fascia becomes filled with blood due to injury to perforating arteries as well as necrotic tissues. Although the MLL is often seen in traumatic injuries to lower extremities, mostly secondary to MVCs, however, they are also seen on trunk and buttocks. The closed cavity formed between subcutaneous tissue and fascia may remain unrecognized for some time. However, often the lesion is easily identified on CT or MRI as well as US images taken as part of complex work up of trauma patient or for soft tissue swelling in patient with history of blunt trauma. With time the closed cavity becomes organized secondary to inflammatory reaction and subsequent development of granulation tissue and the fibrous pseudocapsule. And as the pseudocapsule is formed around the contents of the MLL, patients often have no specific clinical symptoms, except for swelling of the site. The contents of the MLL thus may remain unrecognized for many days or even months.