HSS Ultrasound of the Month Case 103

Clinical History A 24 year old male presents 4 months status post polytrauma from a motor vehicle accident, when he sustained left clavicular and scapular fractures, spine fractures, liver laceration, lung injury and a left hip Morel-Lavallee lesion.

The patient complains of left hip swelling and tenderness to palpation that has not resolved over the last 4 months.

A left hip ultrasound was ordered to evaluate for persistent fluid collection and if one is present, a request was made to aspirate the collection and inject the cavity with doxycycline, a sclerosing agent.

Ultrasound of the Month – Case 103

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Ultrasound of the Month – Case 103

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Diagnosis: Morel – Lavallee Lesion Management Morel – Lavallee lesion percutaneous aspiration, doxycycline injection and subsequent doxycycline aspiration

Ultrasound of the Month – Case 103

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Ultrasound of the Month – Case 103

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Discussion •

Etiology: –

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Pathology: – –

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Most commonly occurs over the greater trochanter; however, may also be seen over the flank, buttocks and knee.

Radiographic features: –

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Traumatic shearing and separation of the subcutaneous tissues from the underlying fascia, yielding a potential space in the perifascial plane, which may contain blood, lymph, debris and fatty tissue.

The collection may resolve on its own or may develop a capsule and persist.

Location: –

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Post-traumatic closed degloving injury

Ultrasound: • Anechoic, hypoechoic, or hyperechoic ovoid encapsulated fluid collection between the subcutaneous fat and fascia, which may contain echogenic debris and may demonstrate associated fluid-fluid levels.

MRI: • Well-defined ovoid fluid collection superficial to the fascia, which demonstrates variable signal intensity and possible associated fluid-fluid levels and septations.

Management: – –

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Acutely, conservative management with elastic compression bandages may be utilized for lesions that have not become encapsulated.

If there is no resolution, percutaneous drainage and sclerodesis with sclerosant agents, such as talc and doxycycline, may be effective.

• Sclerotherapy causes scarring in an attempt to prevent fluid reaccumulation.

However, surgical drainage and open debridement of the capsule may be required to prevent fluid re-accumulation.

Ultrasound of the Month – Case 103

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