55-year-old female presents with an enlarging fluctuant mass along her hip
after a motor vehicle accident one week prior.
the subcutaneous fat overyling the greater trochanter of the femur, there is a
rounded lesion, which is predominantly hyperintense on T2-weighted images and
hypointense on T1-weighted images. Curvilinear hypointensities with the lesion
on T2- weighted images are consistent with debris. The lesion has a thin
hypointense capsule on both T1- and T2-weighted images. The grayscale
ultrasound image demonstrates a nearly anechoic lesion with a small amount of
layering echogenic debris. During the ultrasound examination, the lesion was
Lavallee lesion occurs over the greater trochanter of the femur and results
from a closed degloving injury (or shear injury), which separates the
subcutaneous tissues from the underlying fascia. The lesions tend to
appear within hours to days of the injury. Similar lesions can occur near the
knee, the lumbar spine, and the scapula, although these classically are not
designated by the eponomous term.
After a significant shearing of the subcutaneous tissues from the underlying
fascia, fluid accumulates within the potential space. The fluid contains
variable amounts of lymph, blood, fat, and debris. The Morel Lavellee
lesion occurs within the subcutaneous tissues and may be rounded or represent a
thin fluid collection tracking along the fascia. Underlying fractures are often
present. Ultrasound examination reveals a fluctuant, fluid-filled lesion within
the subcutaneous tissues, which is most often anechoic, although echogenic
debris is often present within the nondependant portions. Occasionally a
fat-fluid level may be present. Magnetic resonance imaging (MRI) is
useful for delineating the underlying fascia and for determining the degree of
encapsulation, an important factor in determining the proper treatment. The
fluid component is most often hyperintense on T2-weighted images and
hypointense on T1-weighted images, but the signal characteristics are affected
by the amount of hemorrhage and fat within the collection.
Treatment is reserved for cases, which do not resolve spontaneously or with
compression bandages. The presence of a capsule suggests that percutaneous
or surgical drainage will be unsuccessful, although success can sometimes be
achieved with drainage and sclerodesis using talc or doxycycline. Once a
collection has become established, surgical excision is often
necessary. Without proper treatment, these lesions are at high risk of
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LT, Dejong S. MRI of a Morel-Lavellée lesion. AJR Am J Roentgenol. 2004;182:1347-1348.
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C, et-al. Sonography of Morel-Lavallee lesions. J Ultrasound Med. 2008;27:1077-1081.
- Mallado JM, Bencardino JT.
Morel-Lavallee lesion: Review with emphasis on MR imaging. Magn Reson Imaging Clin N Am.
- Hak DJ, Olson SA,
Matta JM. Diagnosis and management of closed internal degloving injuries
associated with pelvic and acetabular fractures: the Morel-Lavallee lesion. J Trauma.