Attending Physician University of Cincinnati Cincinnati, Ohio, United States
Case Diagnosis: Moral-Lavallee Lesion Type 2
Case Description: 52 year old male presented with a recurrent left gluteal mass. One month prior, patient fell 25 feet off a tree stand onto his left side with no major injuries besides a sprained wrist and ankle. Within a few days, he noted development of a large bruise at his left buttock which later developed into a circular, indurated area the size of a softball. At presentation, exam revealed a non-painful 8x7 cm circular, non-erythematous, indurated lesion at the superomedial aspect of his left buttock without overlying sensation changes. Ultrasound evaluation revealed a hypoechoic, compressible mass lying between the superficial subcutaneous and deep gluteus maximus layers. An ultrasound-guided aspiration yielded 110 ml of serosanguineous fluid. Within a week, two further aspirations each yielded > 80 ml of similar fluid with development of fibrous septations throughout the lesion. Surgical consultation was subsequently required.
Discussions: Morel-Lavellee lesions are closed degloving soft tissue injuries. Often the result of trauma, there is an abrupt separation of skin and subcutaneous tissue from underlying fascia, where fluids such as blood and lymph can combine with other breakdown products and accumulate. The most common locations are the thigh, hip, and pelvic regions. There are six subtypes based on their shape, description, and imaging findings. Symptoms often include pain, ecchymosis, swelling, a palpable fluctuant collection, and hypoesthesia. Diagnosis can be made clinically but often requires further imaging via Ultrasound or MRI. Definitive management is determined by size, location, and age of the injury and ranges from ultrasound-guided percutaneous aspiration to open debridement and irrigation.
Conclusions: Moral- Lavellee lesions are closed soft-tissue degloving injuries that result in the separation of the skin and subcutaneous tissue from the underlying fascia. These lesions often go undiagnosed, however, ultrasound can be a useful tool for quick point of care evaluation.