1053 - Ultrasound Diagnosis and Compressive Biomechanical Taping of a Lumbar Morel-Lavallée Lesion in a High School Football Player

Case Diagnosis: Our patient was diagnosed with a lumbar Morel-Lavallée lesion after in-office, musculoskeletal ultrasound depicted an elongated, hypoechoic fluid collection overlying the lumbar spine with echogenic subjacent fascia.

Case Description: A 16-year-old male high school football player presented to our musculoskeletal outpatient clinic due to acute lumbar swelling and tenderness after sustaining low back trauma while sliding across a turf field catching a football two weeks prior to presentation. After the diagnosis was made, the patient was instructed to apply ice in the prone position and avoid contact sports and heavy lifting for two weeks. Compressive biomechanical taping was applied to the skin over the lumbar tissues to facilitate lymphatic drainage. During his follow-up visit two weeks later, repeat ultrasound revealed near-resolution of the patient's lesion. He returned to play after a third week of rest and his team won a state championship.

Discussions: Morel-Lavallée lesions are closed, degloving, soft-tissue injuries that result in a fluid collection between the subcutaneous fat and superficial fascia. These lesions are most often located at the greater trochanter, but this patient had a lumbar lesion. Associated symptoms can include fluctuating pain, skin hypermobility, and loss of cutaneous sensation, and delayed treatment can lead to abscess formation, cellulitis, osteomyelitis, necrosis, and superinfection. MRI is the most used imaging modality; however, ultrasound is a quick, cost-effective alternative available in many outpatient offices. The few previous studies that used ultrasound to detect Morel-Lavallée lesions indicated diagnostic challenges due to nonspecific presentation and difficult detection.

Conclusions: This case is unique because most Morel-Lavallée lesions occur at the greater trochanter and are diagnosed using MRI whereas our patient's lumbar lesion was diagnosed with musculoskeletal ultrasound. Early detection and prompt conservative treatment led to a timely recovery and demonstrated the benefits of using in-office diagnostic tools when applicable.