Working Diagnosis:
Morel-Lavallee lesion of calf

Treatment:
Patient was instructed to use compression after the first aspiration to prevent reaccumulation of fluid.
At three week follow-up, repeat aspiration of 20cc fluid was performed in association with 50% dextrose injection for sclerosing effect. This resulted in minimal improvement. Case Photo #3
At six week follow-up, the patient opted for non-surgical treatment. A final 5cc aspiration of fluid with subsequent doxycycline injection was performed, with greater improvement in symptoms.

Outcome:
Follow-up ultrasound showed minimal (2cc) of residual fluid. Patient was able to participate in all activity without pain or swelling.

Author's Comments:
Morel-Lavallee lesions are post-traumatic, closed degloving injuries where the skin and subcutaneous tissue are separated from fascia superficial to an underlying muscle plane. The shearing effect creates a potential space filled with hemolymph and necrotic fat. The lesions are seen mostly in the proximal thigh and trochanteric region, rather than the calf. Diagnosing and treating these lesions early is essential as any delay may lead to infection or necrosis. MRI is the gold standard for diagnosis of these lesions which appear homogeneously hypointense on T1W sequences and hyperintense on T2W sequences. Management is with either surgery, or drainage and sclerosis. Case Photo #6

Editor's Comments:
Some Morel-Lavallee lesions can also be managed conservatively with relative rest and compression. Conservative treatment is recommended only at locations where compression is feasible (e.g. around the knee) and is most successful for small lesions that develop acutely.

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