• Morel-Lavallee
• haematoma
• seroma
• lumbar
• adolescent
• x-ray
• major trauma management
• management
• cost efficiency
• musculo-skeletal
• research
• clinical
• methods

A 14-year-old boy presented to the emergency department with pain and swelling over the lumbar area after blunt trauma of his lower back 2 h previously (after falling from a horse).

On examination, there was a voluminous swelling (20×15 cm) over the lumbar area, overlying segments L2–S4; the swelling was soft, elastic, immobile, painful to palpate, with moderate bruising (figure 1); there was generalised decreased range of movement of the lumbar spine and neurology was normal.

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Figure 1

Clinical images of the lesion.

X-rays showed spondylolisthesis of L5 on S1 and diffuse soft tissue thickening over the posterior and lateral aspects of the lumbar vertebral column (figure 2). The MRI scan confirmed a large solid haematoma and a long-standing stable spondylolisthesis (figure 3).

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Figure 2

Lumbar x-ray: 1.1 cm anterior slippage of the L5 on S1 vertebra with a bilateral defect in the pars interarticularis at this level (black arrow). Notice an increased diffuse soft tissue thickening over the posterior and lateral aspects of the lumbar spine (white arrows).

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Figure 3

MRI scan (standard lumbar spine protocol): large solid haematoma (8.4×4.3×8.3 cm) identified in the subcutaneous tissues overlying the L3–S1 vertebral segments. Chronic bilateral pars defects of L5 with grade I anterolisthesis of L5 on S1, approximately 10 mm of anterior slippage of L5.

Morel-Lavallée lesion (haematoma or seroma) occurs after close blunt trauma, direct or tangential, with a degloving mechanism that separates the hypodermis from the fascia beneath, causing a shearing injury.1 Post-traumatic lesions are often encountered in the region of the hip, thigh and pelvis and very rarely over the lumbar area. This lesion can also appear after plastic, reconstructive or orthopaedic surgery.

The treatment varies from conservative compression methods to surgical drainage or continuous aspiration. For our patient, an open drainage was performed with uneventful postoperative evolution.