A unique soft tissue injury with devastating delayed consequences: A video case report.

Abstract

A 52-year-old male presented to the emergency department (ED) after a fall down 5 stairs resulting in a loss of consciousness. On physical examination, a 4-cm hematoma was identified on the right lateral flank that emergency medical services personnel stated was the size of a golf ball on initial evaluation and appeared to expand over the course of his ED stay. Initial computed tomography (CT) (Figure 1) showed the hematoma; however, a bedside ultrasound (Video 1) and subsequent CT (Figure 2) were performed, demonstrating expansion of the hematoma with active extravasation. The qualities of this hematoma are suspicious for an uncommon condition called a Morel-Lavallée lesion (MLL), a closed degloving injury in which the subcutaneous tissues and fascia are separated by a hematoma that forms most frequently because of shearing forces.1, 2 Previous reports have documented MLLs secondary to motor vehicle collisions1 or biking accidents3 and some in conjunction with traumatic ventral wall hernias.2, 4 Diagnosis of this condition can occur through the use of ultrasound or magnetic resonance imaging, demonstrating a heterogenous fluid collection between the subcutaneous tissue and fascia.3 Although early detection of this condition is critical as the patient may continue to hemorrhage during evaluation, sequelae of this condition can be lifethreatening for a patient. Documented sequelae of MLLs range from infection of the lesion and neurovascular compromise to capsulation and scar tissue formation.3 A high index of suspicion for these lesions in patients with acute or remote trauma is critical as complications can occur up to a year later.3