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Morel-Lavallée Lesion Diagnosed by Point-of-Care Ultrasound: A Case Report and Review of Treatment Strategies

  • Jonathan Gelber
    Correspondence
    Corresponding Author: Jonathan Gelber MD, Department of Emergency Medicine, University of California San Francisco School of Medicine, Box 0208, 533 Parnassus Avenue, San Francisco, CA 94117, USA, Tel (408) 219-5578
    Affiliations
    Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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  • Whitney Sher
    Affiliations
    Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
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Published:November 01, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.10.021

      Abstract

      BACKGROUND

      : Morel-Lavallée lesions, also known as an internal degloving injuries, occur hours to months after high-speed sheering trauma, usually in the peri-trochanteric region. These are uncommon injuries, and are often missed as part of the trauma exam. Failure to diagnose or treat these lesions may result in complications such as infected seromas, chronic cosmetic deformities, capsule formation, or skin necrosis. There are no formalized societal guidelines for management, but smaller studies have recommended compression alone for asymptomatic lesions, aspiration for small symptomatic lesions, and open debridement for large lesions.

      CASE REPORT

      : A young woman presented with swelling, fluctuance, and paresthesia to her right hip after falling off her bicycle 1 week ago. Physical examination showed a fluctuant and hypoesthetic area over the greater trochanter, and point-of-care ultrasound showed a hypoechoic and compressible fluid collection between a fascial layer and a subcutaneous layer, confirming the diagnosis of a Morel-Lavallée lesion (internal degloving injury). Symptoms did not improve with compression alone, but did improve after fluid aspiration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Morel-Lavallée lesions are frequently missed traumatic injuries. Morel-Lavallée Lesions can be quickly and cost-effectively diagnosed in the ED through the combination of a thorough history, physical exam, and bedside ultrasound. While there are no formal societal guidelines, limited studies suggest management strategies including compression, aspiration, and open debridement, with treatments varying by symptom severity and lesion size.

      Keywords

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