Citation, DOI & article data
Morel-Lavallée lesions are closed degloving injuries associated with severe trauma which then present as hemolymphatic collections or masses. MRI and ultrasound are useful modalities for evaluation.
The lesions classically occur over the greater trochanter of the femur 1. Morel-Lavallée lesions, strictly speaking, occur in the thigh. However, similar biomechanical forces to the lumbar region, over the scapula, or over the knee 13 can result in identical lesions and these are often also called Morel-Lavallée lesions 1,3.
Morel-Lavallée lesions typically occur when the skin and subcutaneous fatty tissue traumatically and abruptly separate from the underlying fascia.
The initial injury represents a shearing of subcutaneous tissues away from underlying fascia / muscles along interfascial planes.
The initial potential space created superficial to the fascia is filled by various types of fluid, ranging from serous fluid to frank blood.
The collection may then spontaneously resolve or become encapsulated and persistent.
Some authors have suggested a classification system mainly based on MR assessment 12.
The size of these lesions is variable, ranging from small thin slivers of fluid to thickly encapsulated lesions many centimeters in diameter. When chronic they are typically oval or fusiform in shape and adherent to the underlying fascia.
The Morel-Lavellée lesion will not be demonstrated on a plain radiograph but an underlying fracture may be present. Injuries which are associated with these lesions include femoral and pelvic fractures.
Typically these lesions are anechoic or hypoechoic. As with a standard hematoma, it can be predominantly echogenic in the acute phase, becoming more hypoechoic as blood products liquefy over time 11. Internal debris, including fat globules can give rise to echogenic foci or even fluid-fluid levels 1. A capsule of variable thickness may be seen. The shape may range from flat to mass like.
MRI is able to clearly determine the relationship of the collection with the underlying fascia. The fluid is of variable signal intensity depending on makeup and may even show a fluid-fluid level 1.
Treatment and prognosis
Once these lesions become established and encapsulated then conservative management is rarely successful (e.g. compression bandages). Surgical drainage may be sufficient, although in some instances the capsule needs to be resected to prevent re-accumulation.
History and etymology
It was first described in 1848 by Victor-Auguste-François Morel-Lavallée (1811-1865), a French surgeon 4.
If in a classic location and with a characteristic appearance then little differential exists. In cases where the lesion is heterogeneous in morphology or fluid-fluid levels are present, the possibilities include 1,2:
- 1. Gilbert BC, Bui-mansfield LT, Dejong S. MRI of a Morel-Lavellée lesion. AJR Am J Roentgenol. 2004;182 (5): 1347-8. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Mellado JM, Pérez del palomar L, Díaz L et-al. Long-standing Morel-Lavallée lesions of the trochanteric region and proximal thigh: MRI features in five patients. AJR Am J Roentgenol. 2004;182 (5): 1289-94. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med. 2007;35 (7): 1162-7. doi:10.1177/0363546507299448 - Pubmed citation
- 4. Morel-Lavallée. "Décollements traumatiques de la peau et des couches sous-jacentes." Arch Gen Med 1863; 1:20 –38, 172–200, 300–332
- 5. Neal C, Jacobson JA, Brandon C et-al. Sonography of Morel-Lavallee lesions. J Ultrasound Med. 2008;27 (7): 1077-81. J Ultrasound Med (full text) - Pubmed citation
- 6. Kalaci A, Karazincir S, Yanat AN. Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm. Clin Imaging. 31 (4): 287-91. doi:10.1016/j.clinimag.2007.01.012 - Pubmed citation
- 7. Mellado JM, Bencardino JT. Morel-Lavallée lesion: review with emphasis on MR imaging. Magn Reson Imaging Clin N Am. 2005;13 (4): 775-82. doi:10.1016/j.mric.2005.08.006 - Pubmed citation
- 8. Mukherjee K, Perrin SM, Hughes PM. Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation. Skeletal Radiol. 2007;36 Suppl 1 : S43-5. doi:10.1007/s00256-006-0122-4 - Pubmed citation
- 9. Takahara S, Oe K, Fujita H et-al. Missed massive morel-lavallee lesion. Case Rep Orthop. 30;2014: 920317. doi:10.1155/2014/920317 - Free text at pubmed - Pubmed citation
- 10. Nair AV, Nazar P, Sekhar R et-al. Morel-Lavallée lesion: A closed degloving injury that requires real attention. Indian J Radiol Imaging. 2014;24 (3): 288-90. doi:10.4103/0971-3026.137053 - Free text at pubmed - Pubmed citation
- 11. McLean K, Popovic S. Morel-Lavallée Lesion: AIRP Best Cases in Radiologic-Pathologic Correlation. (2017) Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (1): 190-196. doi:10.1148/rg.2017160169 - Pubmed
- 12. Tineke De Coninck, Filip Vanhoenacker, Koenraad Verstraete. Imaging Features of Morel-Lavallée Lesions. (2018) Journal of the Belgian Society of Radiology. 101 (S2): 15. doi:10.5334/jbr-btr.1401 - Pubmed
- 13. Evangelia E. Vassalou, Aristeidis H. Zibis, Vasileios A. Raoulis, Ioannis P. Tsifountoudis, Apostolos H. Karantanas. Morel-Lavallée Lesions of the Knee: MRI Findings Compared With Cadaveric Study Findings. (2018) American Journal of Roentgenology. 210 (5): W234-W239. doi:10.2214/AJR.17.18614 - Pubmed
- 14. Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management. (2017) Journal of clinical and diagnostic research : JCDR. 11 (4): TE01-TE04. doi:10.7860/JCDR/2017/25479.9689 - Pubmed
- 15. Spain JA, Rheinboldt M, Parrish D, Rinker E. Morel-Lavallée Injuries: A Multimodality Approach to Imaging Characteristics. (2017) Academic radiology. 24 (2): 220-225. doi:10.1016/j.acra.2016.08.029 - Pubmed
- 16. Hussein K, White B, Sampson M, Gupta S. Pictorial review of Morel-Lavallée lesions. (2019) Journal of medical imaging and radiation oncology. 63 (2): 212-215. doi:10.1111/1754-9485.12854 - Pubmed