Working Diagnosis:
Morel-Lavallee Lesion

Treatment:
-Right hip soft tissue aspiration with US guidance: 185 cc of sanguinous fluid aspirated followed by 100mg of Doxycycline in 10cc of 0.9% NaCl were injected as sclerosing agent
-Rotation of hip after sclerosing agent injected with change in position every 10 minutes
-Compression bandage applied and worn for 4 weeks
-Ice and anti-inflammatory medications for pain relief

Outcome:
-Lesion reoccurred after aspiration and Celestone injection
-Swelling, pain and reaccumulation resolved after sclerodesis with Doxycycline.

Author's Comments:
The key learning points about Morel lesions surround the ability to identify them. The history and mechanism of action as well as the clinical presentation are key components of diagnosis although the addition of diagnostic ultrasound at the bedside enhances our diagnostic abilities. These recurrent lesions are difficult to treat. The ability to use sclerodesis at the bedside as an in office procedure is a non invasive and simple mechanism to prevent recurrence.

Editor's Comments:
Morel-Lavallee lesions are a post-traumatic soft tissue degloving injury. Most commonly these occur due to high velocity injuries, such as motor vehicle accidents, but can occur during sport related trauma. They most commonly occur at the lateral hip but can occur in the low back, buttocks, flank, scapula, and knee. The shearing force in these areas cause separation of the hypodermis and deepr fascia. This new potential space accumulates with blood, lymphatic fluid, and fat. Over time blood resorption occurs with increasing serosanguious fluid and fibrous encapsulation that allow for slow expansion. These lesions can be easily seen with ultrasound imaging. MRI remains the gold standard for diagnosis due to high contrast resolution and multiple planes of view. Treatment ranges from rest, compression, NSAIDs, and physical therapy to US-guided drainage with sclerotherapy.

References:
1. Diviti, S., Gupta, N., Hooda, K., Sharma, K., & Lo, L. (2017). Morel-Lavallee Lesions - Review of Pathophysiology, Clinical Findings, Imaging Findings and Management. Journal of Clinical & Diagnostic Research.

2. Scolaro, J., Chao, T., & Zamorano, D. (2016). The Morel-Lavallee Lesion: Diagnosis and Management. The American Academy of Orthopaedic Surgeons, 667-672.

3. Shen C, P. J. (2013). Efficacy of treatment in peri-pelvic Morel-Lavallee lesion: a systemic review of the literature. Arch Orthop Trauma Surg, 635-640.

4. Singh, R., Rymer, B., Youssef, B., & Lim, J. (2018). The Morel-Lavallee lesion and its management: A review of the literature. Journal of Orthopaedics, 917-921.

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