Ramaseshan Karthik, Bauler Laura D, Mastenbrook Joshua
Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA.
Department of Biomedical Sciences, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
BMJ Case Rep. 2020 Feb 25;13(2):e233295. doi: 10.1136/bcr-2019-233295.
A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. The rarity of this condition often leads to misdiagnosis. A 66-year-old man presented to the emergency department after a 300-pound safe sheered across his left anterolateral leg causing skin avulsion, tenderness, swelling, ecchymosis, and erythema. The patient was treated for suspected cellulitis with oral antibiotics, but the lesion evolved into a necrotic eschar necessitating surgical intervention. In hindsight, MLL is a more appropriate diagnosis based on injury mechanism, disease progression and intraoperative findings. A history of shearing trauma with diffuse ecchymosis and erythema should prompt consideration of MLL. Due to rampant misdiagnosis, this case aims to increase awareness, as early diagnosis of MLL will improve patient outcomes.
莫雷尔-拉瓦利埃损伤(MLL)是一种由钝性外力创伤导致皮下组织与深筋膜分离引起的罕见损伤。它常见于涉及髋部或骨盆骨折的骨科病例中,但在小腿中较为罕见。这种病症的罕见性常常导致误诊。一名66岁男性在一个300磅重的保险箱从他左小腿前外侧擦过,导致皮肤撕脱、压痛、肿胀、瘀斑和红斑后,被送往急诊科。该患者因疑似蜂窝织炎接受口服抗生素治疗,但病变发展为坏死焦痂,需要手术干预。事后看来,根据损伤机制、疾病进展和术中发现,MLL是更合适的诊断。有剪切伤史并伴有弥漫性瘀斑和红斑应促使考虑MLL。由于普遍存在误诊情况,本病例旨在提高认识,因为MLL的早期诊断将改善患者预后。