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Long-Standing Morel-Lavallée Lesions of the Trochanteric Region and Proximal Thigh: MRI Features in Five Patients

¹ Institut de Diagnòstic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, Carrer Doctor Mallafrè Guasch 4, Tarragona 43007, Spain.
² Servei de Radiologia, Pius Hospital de Valls, Tarragona, Spain.
³ Servei de Anatomia Patològica, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.

View larger version (154K): [in a new window]   Fig. 1A. —65-year-old man with history of motorcycle crash 34 years earlier. Axial T1-weighted image (TR/TE, 510/15) of hip shows long-standing Morel-Lavallée lesion (white arrow) in deep subcutaneous plane adjacent to fascia lata (black arrows) and vastus lateralis (VL) and rectus femoris (RF) muscles of left proximal thigh. Lesion is mildly hyperintense relative to skeletal muscle and appears to be surrounded by thick hypointense capsule (arrowheads).

View larger version (143K): [in a new window]   Fig. 1B. —65-year-old man with history of motorcycle crash 34 years earlier. Axial T2-weighted image (3,600/120) shows heterogeneous hyperintensity in lesion (arrow) and thick hypointense capsule (arrowheads).

View larger version (136K): [in a new window]   Fig. 1C. —65-year-old man with history of motorcycle crash 34 years earlier. Axial contrast-enhanced T1-weighted image (580/15) reveals patchy internal enhancement in lesion (arrow). Anterior aspect of capsule (arrowheads) also shows mild enhancement.

View larger version (116K): [in a new window]   Fig. 1D. —65-year-old man with history of motorcycle crash 34 years earlier. Photomicrograph of resected specimen shows abundant fibrin, areas of recent hemorrhage, aggregates of organizing thrombus, newly formed capillaries (arrow), and inflammatory infiltrate with polygonal hemosiderin-laden histiocytic cells (arrowhead), consistent with chronic organizing hematoma. (H and E, x400)

View larger version (101K): [in a new window]   Fig. 2. —42-year-old man with history of car crash 4 years earlier. Axial T2-weighted image (TR/TE, 3,600/120) of hip reveals encapsulated long-standing Morel-Lavallée lesion (arrow) in perifascial plane contiguous with fascia lata (arrowheads). Lesion produces mild compressive deformity on adjacent vastus lateralis (VL) muscle, is close to rectus femoris (RF) muscle, and shows internal heterogeneous hyperintensity consistent with chronic organizing hematoma.

View larger version (116K): [in a new window]   Fig. 3. —61-year-old man with history of motorcycle crash 30 years earlier. Axial T2-weighted image (TR/TE, 3,400/120) of hip reveals long-standing Morel-Lavallée lesion (arrow) in perifascial plane contiguous with fascia lata (arrowheads) adjacent to vastus lateralis (VL) muscle. Lesion shows internal heterogeneous hyperintensity and uneven peripheral capsule consistent with chronic organizing hematoma.

View larger version (106K): [in a new window]   Fig. 4A. —59-year-old man with history of accident 3 months earlier. Axial T1-weighted image (TR/TE, 580/15) of hip reveals long-standing Morel-Lavallée lesion (straight arrow) adjacent to fascia lata (curved arrow), in close relationship with muscle bellies of tensor fascia lata (TFL) and gluteus maximus (GM) muscles. Lesion shows thick hypointense capsule (arrowheads) and almost completely homogeneous hyperintense content.

View larger version (113K): [in a new window]   Fig. 4B. —59-year-old man with history of accident 3 months earlier. Axial T2-weighted image (3,600/120) shows homogeneous hyperintensity in lesion (arrow) and thick hypointense capsule (arrowheads). MRI features are consistent with subacute hematoma.

View larger version (115K): [in a new window]   Fig. 4C. —59-year-old man with history of accident 3 months earlier. Follow-up axial T2-weighted image (3,600/120) obtained 33 months after initial study (A) reveals decreased volume of lesion (arrow), which shows heterogeneous internal hyperintensity and thicker capsule (arrowheads).

View larger version (113K): [in a new window]   Fig. 4D. —59-year-old man with history of accident 3 months earlier. Follow-up contrast-enhanced T1-weighted image (580/15) obtained 33 months after A reveals patchy internal enhancement in lesion (arrow) and surrounding capsule (arrowheads), consistent with chronic organizing hematoma.

View larger version (126K): [in a new window]   Fig. 5A. —54-year-old man with history of car crash 28 months earlier. Coronal T1-weighted image (TR/TE, 510/15) of hip reveals long-standing Morel-Lavallée lesion (asterisk), that shows homogeneous hypointensity and dissects virtual space between subcutaneous fatty tissue (arrows) and fascia lata (arrowheads). Lesion is close to gluteus maximus (GM) and biceps femoris (BF) muscles.

View larger version (113K): [in a new window]   Fig. 5B. —54-year-old man with history of car crash 28 months earlier. Coronal STIR image (4,100/29; inversion time, 130 msec) shows homogeneous hyperintensity (asterisk) in lesion. These waterlike MR features correlate with analysis of aspirates and are consistent with serohematic effusion or seroma.

View larger version (118K): [in a new window]   Fig. 5C. —54-year-old man with history of car crash 28 months earlier. Axial T2-weighted MR image (3,600/120) shows lesion (thick arrow) surrounded by hypointense capsule (arrowheads). Internal septum (thin arrow) is also seen.

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