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Emerg Radiol (2014) 21:3543 DOI 10.1007/s10140-013-1151-7
REVIEW ARTICLE
The Morel-Lavalle lesion: pathophysiology, clinical presentation, imaging features, and treatment options
Iris Bonilla-Yoon & Sulabha Masih & Dakshesh B. Patel & Eric A. White &
Benjamin D. Levine & Kira Chow & Christopher J. Gottsegen &
George R. Matcuk Jr.
Received: 25 June 2013 /Accepted: 7 August 2013 /Published online: 16 August 2013 # Am Soc Emergency Radiol 2013
Abstract Morel-Lavalle lesions are posttraumatic hemolymphatic collections related to shearing injury and disruption of interfascial planes between subcutaneous soft tissue and muscle. We review the pathophysiology of Morel-Lavalle lesions, clinical presentation, and potential sites of involvement. Magnetic resonance imaging (MRI) is the modality of choice for characterization. We present the MRI classification and highlight the key imaging features that distinguish the different types, focusing on the three most common: seroma, subacute hematoma, and chronic organizing hematoma. Potential mimics of Morel-Lavalle lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed.
Keywords Morel-Lavalle lesion . Closed degloving injury . Trauma
Introduction
Morel-Lavalle lesions were first described by the French physician Maurice Morel-Lavalle in 1863 as lesions
developing from soft tissue injury to the proximal thigh, resulting in a hemolymphatic collection between the fascial planes [1]. The term has been used subsequently to describe similar lesions in other anatomic sites. Many terms have been given to this soft tissue injury, including closed internal degloving injury, posttraumatic soft tissue cyst, Morel-Lavalle extravasation or effusion, and chronic expanding hematoma [2, 3].
These lesions are primarily the result of severe trauma to the pelvis or thigh, with motor vehicle collisions comprising the most common mechanism [3]. They can also result from low-velocity crush injury, for which the thigh is the most common site. These lesions can also be associated with contact sports, such as football and wrestling [4, 5].
The mechanism of injury is usually trauma that occurs tangential to fascial planes, resulting in a shearing type of injury [6]. For example, lateral to the greater trochanter, the anatomical soft tissue layers include the superficial fascia, which is deep to the dermis with subcutaneous fat, and the deep fascia, composed of the iliotibial tract of the fascia lata,...