Delayed Presentation of a Morel-Lavallee Lesion
A 28 year old male presented with a 40cm mass along the lateral aspect of the left thigh without discharge or skin changes. He had difficulty ambulating and pain in his left thigh and lower back due to the weight of the mass. He had presented 2.5 years prior after an automobile vs pedestrian accident without fracture but with swelling of the left lateral thigh. Concern for a traumatic hematoma prompted drainage via catheter and 600mL were removed, but the mass rapidly reaccumulated fluid when the catheter was removed one day after placement. Patient was lost to follow up for 2.5 years until presenting with the increased left leg diameter, impaired mobility, and hip and back pain. He was evaluated by CT, STIR MRI, and T1W MRI and diagnosed with a chronic Morel-Lavallee Lesion of the left lateral thigh. He underwent seroma evacuation and capsule resection with drainage of 4000mL of fluid. CT imaging with contrast indicated normal joint spaces, anatomic alignment, and unremarkable vascular structures and muscles without evidence of fracture or dislocation. MRI indicated a well-circumscribed structure in the subcutaneous tissues that demonstrated hypointensity on T1WI and increased STIR signal. This case unique due to the 2.5 year delay in presentation and the large size of the lesion. The persistence of this lesion combined with the dramatic length of time between trauma and diagnosis demonstrate the importance proper diagnosis and appropriate treatment of Morel-Lavallee Lesions.