Difference between Morel Lavallee Lesion and Hematoma

What is a Morel Lavallee Lesion?

A Morel Lavallee Lesion is a closed soft-tissue degloving injury in which an extensive section of skin is completely torn off from the underlying tissue of the affected part. A degloving injury in the form of Morel Lavallee Lesion refers to an avulsion or surface trauma where the outermost layer of the skin has been completely cut off in the form of “removing a glove.”

Morel Lavallée Lesions have derived their name from French physician Maurice Morel-Lavalee who first described the condition in 1853.

What is a Hematoma?

A Hematoma is a collection of blood outside blood vessels caused by injury or during a surgical procedure. Hematoma is a common phenomenon and is observed immediately after bruises or falls. Sometimes, the problem can result from medical conditions as well.

Medically Hematoma is called ecchymosis and can occur anywhere in the body. Because of their nature of occurrence, especially in the soft tissues, morel lavallee lesions and hematomas are sometimes confused as similar, which is not the case.

Below mentioned are some differentiating features between Hematomas and Morel Lavallee Lesions

Differentiating Features between Morel Lavallee Lesion and Hematoma

Occurrence Point

Morel Lavallee Lesions occur in the top layers of skin and tissues and mostly affect the legs.

Image Credit

Hematomas can occur in any area of the system with blood vessels or capillaries. When near the skin or subcutaneous regions, they appear more superficially than a Morel Lavallee Lesion.

Incidence

Morel Lavallee Lesion is a rare phenomenon with a prevalence of approximately 1.56%.

A study conducted on 3279 trauma patients over five months showed only 1% (33) MLLs in trauma patients with underlying fractures and 0.56%(18).

The incidence of Hematoma depends on its site of occurrence. For example, Superficial hematomas are very common, impacting most people with injuries. Subdural Hematomas, or clotting of blood vessels between the skull and the brain, have an incidence of 14.7 out of 100,000 individuals in the U.S. Epidural Hematoma in people with head injuries is approximately 2-15%.

Physiology

Morel Lavallee Lesions are traumatic closed degloving injuries occurring in the subcutaneous plane or skin layer just above the muscle plane and result in the accumulation of hemolymph with necrotic fat.

Image Credit

Hematoma occurs when the blood vessels in an area start leaking and pooling in the surrounding tissues.

Image Credit

Causes

Morel Lavallee Lesions can occur because of

Accidents involving industrial or farm equipment
Construction accidents
Car or Motorcycle accidents
Animal Bites
Falling from heights

Hematomas can occur because of

Traumatic conditions
Effect of medications
Viral Infections
Aneurysms
Orthopedic complications like fractures

Classification

Image Credit

Types of Morel Lavallee Lesions

Type 1 – laminar shaped and seroma like

Type 2 – oval shaped resembling a subacute hematoma

Type 3 – oval shaped resembling chronic organizing hematoma

Type 4 – linear, like a closed laceration

Type 5 – pseudo nodular with a round shape
Type 6 – infected with a thick capsule and peripheral enhancement

Classification of Hematoma

Based on its location, a Hematoma can be

Subcutaneous – under the skin

Subungual – under the toenails

Retroperitoneal – inside the abdominal cavity without involving the organs

Hepatic – in the liver

Splenic – in the spleen

Intracranial – between the skull and lining of the brain

Subdural – between the brain tissue and the internal lining of the brain

Symptoms

The most common symptoms of Morel Lavallee Lesions are

Pain
Swelling
Palpable fluctuant collection over the injured area
Hypoesthesia

The symptoms of Hematoma vary as per the area of its occurrence. E.g.-

Subcutaneous hematoma results in red swelling, purplish bruises, a warm sensation of pain
Subungual hematoma results in discoloration of the nail
Intracranial Hematoma leads to slurred speech, vomiting, dizziness, unequal pupil size
Intracranial Hematoma leads to slurred speech, vomiting, dizziness, unequal pupil size

External appearance

Morel lavallee Lesion

Image Credit

Intramuscular Hematoma

Image Credit

Impact on blood vessels

A Morel Lavallee Lesion results in proliferative damage to capillaries and blood vessels in the affected area.

Hematoma partially damages the blood vessels resulting in seepage of blood to the surrounding areas. But it does not destroy them.

Microscopic Appearance

Image Credit

Image 1 – Morel Lavallee Lesion

Image Credit

Image 2 – Hematoma

Impact on tissue

Morel Lavallee Lesions damage the tissue and lead to their necrosis in severe conditions because of disruption of blood vessels caused by the impact.

Whether or not a hematoma can impact the tissue depends on its position and how promptly it is treated. Studies have shown that intracranial and traumatic subcutaneous Hematoma can cause significant tissue damage if left untreated. Hematoma under the nails though painful, does not cause tissue damage.

Diagnostic Methods

Diagnosis of Morel Lavallee Lesion is based on the history of the patient, physical examination conducted by a medical expert, and imaging methods. Some of the diagnostic procedures used are

Ultrasound – that helps diagnose the fluid mass

MRI – that helps in differentiating from hematomas

CT Scans

Diagnosis of Hematoma is conducted through physical examination and CT scans.

Treatment Method

Morel Lavallee Lesions are notoriously challenging to treat because of the secondary infections that develop over them. Some of the chief treatment options for MLLs are

Sclerosing agents like Erythromycin, Bleomycin, Absolute Alcohol
Surgical interventions like Skin Grafting or Local Flap-Based Reconstruction

Hematomas, especially when of a superficial origin, are self-treatable and don’t require medical intervention. Treatment for hematomas include

RICE Method ( Rest, Ice, Compression, and Elevation )
Over The Counter painkillers, if required
Occasionally, Surgical intervention if it impacts the vital organs

Differential Diagnosis

Differential Diagnosis of Morel Lavallee Lesion includes

Seroma
Hematoma
‘Soft Tissue Malignancy
Bursitis or inflammation of the protective covering of the bones
Abscess

Differential Diagnosis of a Hematoma depends on its area of occurrence. For Eg-

Subcutaneous Hematoma is differentially diagnosed with a bruise
Subdural Hematoma in the brain is differentially diagnosed with a brain tumor, hemorrhagic stroke, and neurosyphilis
Spinal Hematoma is differentially diagnosed with Spondylitis

Tabular Representation

Characteristics	Morel Lavallee Lesion	Hematoma

Definition	Closed soft-tissue degloving injury	Collection of blood outside of blood vessels
Occurrence	Top layers of skin	Anywhere in the system, including skin
Incidence	Rare	Variable factor
Physiology	Formed in a subcutaneous plane through the destruction of skin and capillaries	Formed because of leakage of blood vessels
Causative Factors	Trauma	Traumatic, systemic, and surgical factors
Classification	Five subcategories based on skin affection	Classification based on the area of occurrence
Symptom	Pain, swelling, fluctual collection	It depends on which area of the system is impacted
Impact on blood vessels	Completely destroyed	Leal but are not destroyed
Impact on tissue	Tissue damage throughout the affected area	Tissue damage may occur in some cases
Diagnosis	Physical examination, MRI. CT scan	Self Diagnosis. Physical examination with occ MRI/CT scan
Treatment	Surgical or systemic intervention	Self-treatment, OTC painkiller, systemic intervention
Differential Diagnosis	Seroma, Hematoma	It depends on the area of the Hematoma

Difference between Morel Lavallee Lesion and Hematoma

What is a Morel Lavallee Lesion?

What is a Hematoma?