Working Diagnosis:
The fluid collection on MRI was felt to be representative of hemolymph and necrotic fat secondary to a posttraumatic, closed degloving injury. This is diagnostic of a Morel-Lavallee lesion.

Treatment:
The athlete was treated with ice and compression for ten days without improvement. He then underwent an ultrasound-guided doxycycline sclerodesis procedure Case Photo #1 and was advised to continue sleeve compression.

Outcome:
One week later he had significant reduction in pain and minimal fluid reaccumulation on ultrasound. The athlete had continued improvement but was unable to return to full football activities for over one month.

Author's Comments:
Morel-Lavallee lesions are post-traumatic degloving soft-tissue injuries in which the skin and subcutaneous tissue are separated from the underlying fascia. This space can fill with blood, lymph fluid and necrotic fat. Infection and local tissue necrosis can occur as complications. The condition usually occurs over bony prominences secondary to high-velocity trauma, although it has been reported in athletic traumatic injuries as well. Treatments include external compression, serial aspirations, sclerodesis and surgical debridement. While compression and aspiration are effective in most cases, a select few continue to reaccumulate fluid. Sclerodesis with doxycycline has been reported to be effective in refractory cases. The use of doxycycline sclerodesis in the early management of a Morel-Lavallee lesion can effectively decrease fluid pocketing but may not expedite return to play, as symptoms may stem primarily from associated soft-tissue injury or, in this case, concomitant patellar cartilage injury.

Editor's Comments:
A variety of treatment options exist to promote resolution of Morel-Lavallee lesions. These lesions are more commonly seen in high velocity traumatic injuries and documented in surgical literature, but can occur in sports. The area most frequently affected is the peritrochanteric region due to its large surface area, tissue mobility, and dense soft tissue vascularity. Size of the area involved may necessitate surgical intervention to remove necrotic debris, though percutaneous drainage, compressive banding, and sclerosing therapy with doxycycline can also be effective.

References:
Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management. J Clin Diagn Res. 2017 Apr;11(4):TE01-TE04
Scolaro, JA, Chai T, Zamorano, D. The Morel-Lavallee Lesion: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(10):667-672.

Return To The Case Studies List.