Lumbar Morel-Lavallée lesion: a case report and review of the literature

OBJECTIVES: Here we describe a rare post-traumatic lesion and discuss its management. BACKGROUND: Lumbar Morel-Lavallée is a rarely reported lesion. The cause is usually post-traumatic in a polytraumatic context, and care is often focused elsewhere. This leads to misdiagnosis with a risk of chronic pain and infection. In addition, there is no consensus for the management as few cases have been reported so far. CASE REPORT: A 35-year-old African woman was involved in a motor accident. Physical examination at the emergency department revealed moderate head trauma, a lumbar inflammatory mass, and a closed leg fracture. She underwent a whole-body computed tomography scan, which revealed a left frontal brain contusion and a large left paraspinal mass in favor of a lumbar Morel-Lavallée lesion. She benefited from osteosynthesis and conservative management of the cerebral and lumbar lesions. After 4 days, she complained of headaches and vomiting. Magnetic resonance imaging was requested. There was resorption of the cerebral contusion, and the lumbar mass was heterogeneous. She was discharged 10 days later without lower back pain and fully recovered from the headaches. Ultrasound of the lumbar soft tissue performed a month later showed no more collection. CONCLUSION: More frequent in young men, lumbar Morel-Lavallée lesion is underdiagnosed. Thus, there is no consensus on its treatment. However, conservative management followed by close monitoring is advisable in the acute phase. Other therapy includes surgery with or without the use of sclerosing agents. Early diagnosis prevents infections. Although the diagnosis is clinical, magnetic resonance imaging is the critical paraclinical examination for its assessment. Our case is interesting because it occurs in a woman following polytrauma, and to the best of our knowledge, it is an extremely rare lesion, especially in women.