|
 
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| CASE REPORT |
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| Year : 2022 | Volume
: 17
| Issue : 4 | Page : 972-974 |
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A rare case of morel-lavallee lesion
M Naga Meena Lochini1, Thanka Johnson1, Natarajan Suresh1, Karthikeyan Selvaraj2
1 Department of Pathology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 10-Dec-2021 |
| Date of Acceptance | 14-Apr-2022 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Dr. Thanka Johnson
Department of Pathology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_455_21
Morel-Lavallee lesion (MLL) is a closed soft-tissue degloving injury caused by shearing force abruptly separating the skin and superficial fascia from the deep fascia and creating a potential space. Blood, lymphatic fluid, and debris collect and fill the space. The thigh, hip, and pelvic regions are the most commonly affected regions. Apart from the classic location over the region of the greater trochanter, MLLs have been described in other parts of the body. We present the case of a 67-year-old female patient with a past medical history of hypertension presented with a gradually growing swelling of the right gluteal region of 4-week duration, associated with pain on movement and relieved on rest and with no previous history of trauma, pain, or inability to walk. Ultrasonography of the right gluteal region revealed a well-defined localized collection measuring 8.0 cm × 5.1 cm × 2.6 cm with internal septations and few solid components with peripheral vascularity noted in the right gluteal region. Surgical excision specimen of the same was sent for histopathological examination, and a diagnosis of MLL was made. 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.
Keywords: Degloving injury, morel-Lavallee lesion, posttraumatic injury
How to cite this article:
Lochini M N, Johnson T, Suresh N, Selvaraj K. A rare case of morel-lavallee lesion. J Datta Meghe Inst Med Sci Univ 2022;17:972-4 |
| Introduction | |  |
Morel-Lavallee lesion (MLL) was first portrayed in 1863 by the French specialist Victor Auguste Francois Morel-Lavallee while analyzing fatty tissues.[1] MLL is believed to be arising in from strenuous exercise related to bodybuilding and in person involved in sports.[2] The high-energy shearing forces, as a result, separate the skin and subcutaneous tissues from the solid underlying fascia with resultant potential space which is filled with lymph, blood, and serous fluid.[3] This is an uncommon entity and has unknown exact incidence rate. Male-to-female predilection is 1:1 for this lesion. The peritrochanteric region is the most common site; besides, multifocal locations of MLL in the pelvis, lumbosacral, gluteal, thigh, and calf regions are well accepted.[4]
| Case Report | | |
A 67-year-old female patient with a past medical history of hypertension presented with a gradually growing swelling of the right gluteal region of 4-week duration, associated with pain on movement and relieved on rest and with no previous history of trauma, pain, or inability to walk. Local examination revealed a nontender, soft, and globular right gluteal swelling measuring approximately 8 cm × 6 cm with no dilated veins.
The clinical diagnosis of MLL was made.
Routine investigations conducted showed normal findings. Ultrasonography of the right gluteal region revealed a well-defined, localized collection measuring 8.0 cm × 5.1 cm × 2.6 cm with internal septations and few solid components with peripheral vascularity noted in the right gluteal region. Surrounding soft-tissue edema with the associated collection was noted, and the skin appeared normal. Incision and drainage was done and specimen of the same was sent for histopathological examination. No bacterial organism or growth was cultured from the fluid. Compression dressing was applied, and the patient was discharged without any complications after a few days.
Gross description
Specimen consisted of four gray-white, glistening, soft-tissue bits, largest measuring 2 cm × 1 cm × 0.5 cm and the smallest measuring 1 cm × 0.5 cm × 0.2 cm. Cut surface showed gray-white areas.
Microscopic features
Histopathological examination of H and E stain showed fibrotendinous and fibrocollagenous tissue with areas of hemorrhage, hemosiderin-laden macrophages, amorphous eosinophilic material [Figure 1], foamy macrophages, giant cells [Figure 2], and large areas of proliferating vascular channels [Figure 3]. The diagnosis of MLL was given after correlation with clinical diagnosis and radiological findings.
| Discussion | | |
MLLs are the skin and surface fascia isolated from the deep fascia, and are a damage removable to the lesion after injury by producing a possible universe.[2],[5],[6] Damage to rich blood vessels and lymphatics leads to the accumulation of blood and liquid of lymph in this potential space generated by the separation of the surface and the deep fascia. Blood products and necrotic substances cause chronic inflammatory responses. Further, the blood tissues, necrotic adenoid tissues, chips, and fibrin were increased, and fibrillation lesions will be encapsulated by fibrous capsules.[4],[7],[8] Morel-Lavallee injuries usually exist as a site involved as vibrant dyed. Many of these visit the initial evaluation of trauma[9] and may appear from weeks to months. The lesions have been reported more frequently in a large number of regions or proximal thighs, but other locations have been reported, such as lower lumbar areas or calf.[10],[11] In addition, they are associated with pelvic fractures or acetabular. Although there are less number of cases that are associated with strenuous exercise involved in bodybuilding and individuals who are involved in sports, they failed to elucidate the history of these patients and an anatomical and excessive regional trauma.
Fat necrosis, hematomas linked with coagulopathy, soft-tissue tumors, and cold abscesses are all the list of possible diagnoses of Morel-Lavallee. Fat necrosis is more frequently observed in the tibia and buttocks area and is shown as direct internal hyperintensity on magnetic resonance imaging (MRI).[12] The evaluation of coagulation history and parameters is crucial. In addition, identifying the hematomas related to coagulation dysfunction also plays a vital role. The lack of a history of lesions that are difficult to expand dynamically makes our case different from the fine-tissue sarcoma of Morel-Lavallee. Cold tuberculosis abscesses can also gradually develop and grow to a huge size without showing any burning characteristics. MRI and ultrasound help in the imaging of Morel-Lavallee lesion based on different levels of basal fascia.[13] In fact, it illustrates the fibrous or false sac containing hemosiderin, which is a sign of this situation.[1],[14]
The visualization of Morel-Lavallee relies significantly on the time to commencement of treatment and the degree of hidden injury. Depending on the level and severity of damage, pseudocapsule forms for which percutaneous drainage is advised along with pressure gauzing. Basic pressure gauzing alone has been displayed to viably treat numerous instances of Morel-Lavallee. Surgical extraction is normally justified for persistent Morel-Lavallee in which traditionalist administration is ineffective.[15] Although Morel-Lavallee lesion can be debrided of necrotic tissue, it may allow for infection if the wound is left open.[16]
| Conclusion | | |
We present a rare case of MLL of unknown cause. Although Morel-Lavallee injuries are usually related to trauma, they should also be included in cystic masses in the area around the pelvis. Clinical diagnosis and imaging studies followed by histopathological examination can aid in the early diagnosis and management of such patients. Knowledge of the condition can facilitate early recognition by the surgeon, which allows for a prompt intervention to avert complications.
Acknowledgment
I spent my heartfelt gratitude to the patient who cooperated to the whole study. Also, I extend my gratitude to my professor who helped me to complete this study.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
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