Moulin C, Barthélémy I, Emering C, D'Incan M
Service de dermatologie, université d'Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Service de chirurgie maxillo-faciale et chirurgie plastique, université d'Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Ann Dermatol Venereol. 2017 Jun-Jul;144(6-7):450-454. doi: 10.1016/j.annder.2017.01.020. Epub 2017 Apr 7.
Dermal and subcutaneous inflammation following direct trauma is initially evocative of soft-tissue infection. However, two differential diagnoses must be considered: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis.
Case 1: a 51-year-old woman fell off her motorbike and had dermabrasions on her right and left tibial ridges that rapidly developed into dermo-hypodermitis of the entire limb. There was no improvement after 3 weeks of antibiotics. The patient was apyretic. She had a soft, non-inflammatory tumefaction on the inner aspect of her left knee. Ultrasound revealed subcutaneous collection in both legs. The surgeons confirmed a diagnosis of Morel-Lavallée syndrome and drained the two collections. Progress was good and the patient healed without major consequences. Case 2: following a fall on her stairs, a 40-year-old woman presented dermabrasions and haematomas on her left leg. Antibiotic therapy failed to prevent the progression of dermo-hypodermitis. The patient remained apyretic and there was no inflammatory syndrome. A CT scan showed thickening of a subcutaneous fat and fluid collection, resulting in diagnosis of post-traumatic nodular fat necrosis. Management was surgical and the outcome was good.
These two cases show two post-traumatic cutaneous complications: Morel-Lavallée syndrome and post-traumatic nodular fat necrosis. Morel-Lavallée syndrome occurs after tangential trauma next to richly vascularized tissue. Post-traumatic nodular fat necrosis is defined as necrosis of adipocytes. In both cases, diagnosis is confirmed by imagery (Ultrasonography, tomography).
Our two case reports show that inflammatory presentation of both Morel-Lavallée syndrome and post-traumatic nodular fat necrosis can lead to diagnostic and therapeutic errors while a surgical procedure is necessary since tissue necrosis can occur.
直接创伤后的皮肤和皮下炎症最初让人联想到软组织感染。然而，必须考虑两种鉴别诊断：莫雷尔-拉瓦利综合征和创伤后结节性脂肪坏死。
病例1：一名51岁女性从摩托车上摔下，左右胫骨嵴有擦伤，迅速发展为整个肢体的真皮-皮下组织炎。使用抗生素3周后无改善。患者无发热。左膝内侧有一个柔软、无炎症的肿块。超声显示双腿有皮下积液。外科医生确诊为莫雷尔-拉瓦利综合征，并引流了两处积液。恢复良好，患者痊愈，无严重后果。病例2：一名40岁女性在楼梯上摔倒后，左腿出现擦伤和血肿。抗生素治疗未能阻止真皮-皮下组织炎的进展。患者仍无发热，也没有炎症综合征。CT扫描显示皮下脂肪增厚并有液体积聚，诊断为创伤后结节性脂肪坏死。治疗方法为手术，结果良好。
这两个病例展示了两种创伤后皮肤并发症：莫雷尔-拉瓦利综合征和创伤后结节性脂肪坏死。莫雷尔-拉瓦利综合征发生在富含血管组织旁的切线伤之后。创伤后结节性脂肪坏死定义为脂肪细胞坏死。在这两种情况下，通过影像学检查（超声、断层扫描）确诊。
我们的两个病例报告表明，莫雷尔-拉瓦利综合征和创伤后结节性脂肪坏死的炎症表现可能导致诊断和治疗错误，而由于可能发生组织坏死，手术治疗是必要的。
