Akademik Veri Yönetim Sistemi
TMRD 2021, Ankara, Türkiye, 23 - 25 Eylül 2021, ss.29-30
Objective: It is aimed to define the MRI characteristics of pediatric Morel-Lavallee lesions and to evaluate the parameters related to
the need for treatment.
Material-Methods: MR images and clinical follow-up of 22 pediatric patients diagnosed with Morel-Lavallee lesion clinically and
radiologically were evaluated retrospectively. The subcutaneous collections were evaluated for location, shape and signal characteristics
including the presence of fat, blood products, septations and also the
presence of the thick capsule. The presence of internal fat droplet in
the collection was used as a diagnostic criterion for Morel-Lavallee
lesion. In addition, it was evaluated which patients required drainage treatment and which MRI findings were helpful in determining
the treatment plan. Frequency and percentage distribution methods
were used in the statistical analysis. Chi-square test was used to compare the groups.
Results: Of 22 patients diagnosed with Morel-Lavallee lesions,
77% (n=17) were male and 23% (n=5) were female. Patients
ranged in age from 7 to 18 years, with a mean of 13.2 years (+/-2,3).
The locations of Morel-Lavallee lesions were knee (77%, n=17,
15 patients had anterior knee and 2 patients had posterior knee
involvement), hip (14%, n=3) and thigh (9%, n=2) in order of
frequency. These lesions all had a similar ovoid shape. Twenteen
(55%) had septation, 8 of them had one and 4 of them had multiple
septations. Six (27%) had internal blood products and percutaneous
drainage was performed in 3 of these patients. 2 (9%) had thick capsule (>2mm) ve both of them was treated by percutaneous drainage.
The majority of patients (18/22) received solely conservative management but three patients underwent percutaneous drainage. All of
the patients who received treatment were over 11 years old. Older
age (over 11 years), the presence of thick capsule and hemorrhagic
content of subcutaneous collection were risk factors for treatment
and were statistically significant. (p<0.05).
Discussion-Conclusion: Morel-Lavallee is a closed degloving
injury, which results from shearing injury that separates the subcutaneous layers from the fascia and it represents a potential space.
Then, hemolymphatic collection fills the potential space. Although it
is mainly defined in adults when located at the hip in the literature,
a limited number of cases in the pediatric age group have been reported. Unlike adults, Morel-Lavallee lesions most commonly affect
the knee and especially the anterior knee in children. Lesions are
usually ovoid shape and may contain septa, internal blood productsand thick capsule. The presence of the internal fat droplet in the collection is an important criteria for the diagnosis of the Morel-Lavallee
and it is required for differential diagnosis from other post-traumatic
pathologies such as hematoma and prepatellar bursitis. The majority
of patients receive conservative management but older age (>11
years old), the presence of the hemorrhagic content and thick capsule in the collection are MRI findings that can guide the clinician
in determining the need for percutaneous drainage. Morel-Lavallee
lesions can be misdiagnosed by clinicians-radiologists since they
are not very common in the pediatric age group, so Morel-Lavallee
should definitely be considered in the differential diagnosis, especially in the presence of a subcutaneous collection in the anterior knee
(1,2).