Morel-Lavalle lesion or Closed Internal Degloving Injuries
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Case Summary
A 56-year-old police officer was involved in an altercation in August 1995 during which he sustained multiple stab wounds. Initial evaluation by Physical Medicine and Rehabilitation (PM&R) in February 2010 was for chronic left hip pain worsening over the past five months. He reported 4 to 5-year history of localized “band-like pain” around the left hip with a second sharp inguinal pain. The pain was characterized as deep, achy, throbbing and constant; better in the morning and progressively worse later in the day; alleviated with Vicodin, ASA, NSAID; and aggravated by activity and prolonged sitting. Objective examination noted for mild tenderness at the mid-line thigh/inguinal junction and decreased sensation in the left thigh consistent with meralgia paraesthetica.

The patient underwent a protracted course of treatment with multiple evaluations by various specialties, including PM&R, interventional pain, orthopedics, rheumatology and interventional radiology. An interventional pain specialist performed multiple ultrasound-guided fluid aspirations over a two-year period. Fluid was initially noted to be translucent yellow in color and progressed over the course of aspirations to serosanguinous in nature. Repeated fluid analysis noted no growth. Patient subsequently underwent surgical excision. Pathology confirmed suspected diagnosis. Patient initially experienced excellent pain relief sustained for two months. However, follow-up established insidious return of previous symptoms.

Imaging Findings
Diagnostic studies included MRI, which revealed a fluid collection consistent with ganglion cyst under the left tensor fascia lata.
Subsequently, the imaging was re-reviewed with musculoskeletal radiology and the MRI picture was most consistent with Morel-Lavalle lesion.

Diagnosis
Morel-Lavalle lesion. Differential diagnosis includes ganglion cyst, fat necrosis, sarcoma, hemangioma, subcutaneous hematoma, aneurysmal bone cyst.

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