PMC4861867_01
An AP radiograph of the elbow shows soft-tissue swelling at the medial aspect of the elbow (white arrow), in the region of the medial epicondyle, with loss of the normal fat planes.
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While in the Emergency Department, the patient was seen by Orthopedics, had elbow radiographs performed (Fig. 1), and had approximately 5 cc of fluid (described as "venous blood") aspirated from the area of swelling.
A. Targeted ultrasound evaluation of the soft palpable mass located over medial epicondyle (asterisk) with a high-frequency linear transducer (12 to 5-MHz transducer) demonstrates a complex collection (arrowheads) located between the subcutaneous fat and fascia. The lesion contains highly echogenic lobules of fat, interspersed with areas of lower echogenicity. B. Color Doppler imaging of the Morel-Lavallee lesion demonstrates minimal flow in two small vessels (arrows) traversing the collection, and absence of flow in the lesion otherwise.
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Over the next week, the patient's swelling worsened, and he had an ultrasound examination of the area of pain and palpable mass (Fig. 2).
Axial T1W (TR/TE 800/10) (A) and T2W fat saturated (TR/TE 3617/64) (B) sequences. A Morel-Lavallee lesion overlies the fascia (black arrows) in the region of the medial epicondyle (asterisks). The lesion is predominately T1 hypointense, and T2 hyperintense. There are scattered T1 hyperintense foci (white arrow), with loss of signal on the fat-saturated sequences, consistent with fat lobules.
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Unenhanced MRI, performed the following week, demonstrated an irregularly shaped, 4.2 x 3.7 x 1.4-cm (longitudinal x AP x transverse) lentiform unilocular T2 hyperintense collection that contained numerous fat globules overlying the deep fascia of the elbow and draping over the medial epicondyle (Figure 3, Figure 4).
Coronal T1W(TR/TE 633/19) (A) and PD fat saturated (TR/TE 2833/32) (B) sequences. Morel-Lavallee lesion is seen superficial to the fascia (black arrow), overlying the medial epicondyle. A tubular structure (white arrow) surrounded by fat is also seen coursing through the collection, representing sheared-off subcutaneous venous branch.
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Unenhanced MRI, performed the following week, demonstrated an irregularly shaped, 4.2 x 3.7 x 1.4-cm (longitudinal x AP x transverse) lentiform unilocular T2 hyperintense collection that contained numerous fat globules overlying the deep fascia of the elbow and draping over the medial epicondyle (Figure 3, Figure 4).