Disclosures: Alexander J. Carrese, DO: No financial relationships or conflicts of interest

Case Description: Patient is a 46 year old female that presented to a level one trauma center after sustaining injuries in a motor vehicle collision. She was a restrained passenger and was found to have a left posterior frontal lobe subarachnoid hemorrhage, left elbow laceration, multiple rib fractures on the right, bilateral thigh hematomas and closed left comminuted fibular fracture. She was stabilized on the acute floor and admitted to the inpatient rehab facility. During this stay, she developed right>left anterior thigh pain. CT of the right lower extremity was done which stated concern for a possible Morel-Lavallee lesion. MRI Femur was done next which again stated the potential for “RIGHT > LEFT Type I Morel Lavallee Lesions”.

Setting: Inpatient Rehabilitation

Patient: 46 Year Old Female

Assessment/Results: Due to concern for pain, necrosis and possible infection secondary to the bilateral Morel-Lavallee lesions, orthopedic surgery operated on the patient. She underwent an aspiration on the left thigh and an incision and drainage on the right. She tolerated the procedures well and had immediate relief in both lower extremities the next day. Patient has since been seen by both PM&R and orthopedic doctors. She is recovering appropriately with return to weight bearing on the right and no residual issues in her thighs except for minimal tenderness and swelling.

Discussion: Morel-Lavallee lesions are defined as post-traumatic, closed degloving injuries deep to the subcutaneous plane which leads to rupture of capillaries and results in effusion that contains hemolymph and necrotic fat. It is estimated to occur in 8% of trauma events however it is often missed or misdiagnosed. Early diagnosis and management is essential due to concern for the lesion to become infected or necrotic.

Conclusion: This case highlights a unique case of bilateral Morel-Lavallee lesions that required surgical intervention to possibly prevent further complications consistent with this unique injury.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-morel-lavallee-lesions-after-a-motor-vehicle-collision-a-case-report/