Nor Fazliatul Azrin1, Azma Haryaty Ahmad1, Balarajan Nagaraja1 and Zulrushdi Md Yusof2
1Emergency and Trauma Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
2Radiology Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
Transient and non-responders to fluid and blood replacement remain the major resuscitative issues for emergency personnel. We brought up trauma cases which rarely been diagnosed or investigated in ED. These cases also enlightened the importance usage of bedside MSK ultrasound which rarely been performed in ED as a diagnostic tool for persistent hypotension.
A 27 years old gentleman, motorbike rider allegedly involved in lorry rolled over his left thigh. He complained of persistent severe pain over the left(L) pelvic region with unstable hemodynamics despite of multiple fluids and blood resuscitation. Physical examination noted swelling and multiple abrasion wounds over the lateral aspect of left thigh. Extended Focused Assessment Sonographic in Trauma(eFAST) was negative. Musculoskeletal(MSK) ultrasound of the (L) lower limb revealed blood collection extending from (L) iliac crest with 8cm width and 28cm length. Radiological examination of the pelvic and femur revealed no fracture. Computed Tomography(CT) hip confirmed the MSK ultrasound finding performed earlier. Patient was admitted under orthopedic for blood evacuation.
A 59 years old lady, pillion rider felt on her (L) side after involved in motorbike skidded. She complained of pain over the (L) thigh with unstable hemodynamics. Examination showed (L) thigh swelling measuring 10X10cm with abrasion wounds. Radiological examination of the pelvic and (L) femur revealed no fracture. MSK ultrasound showed collection of blood extending from upper thigh measured 12X10cm. Magnetic Resonance Imaging(MRI) confirmed the bedside MSK ultrasound findings. Patient was admitted for compression bandage.
Morel-Lavallée lesions are uncommon post-traumatic internal degloving injuries which associated with significant comorbidities if detected late. This acute or chronic accumulation of fluid in between the fascia and muscle can mimic a deep vein thrombosis or compartment syndrome. Bedside MSK ultrasound plays an important role in expediting diagnosis, management and early referral for definitive care.
Morel-Lavallee, musculoskeletal, ultrasound, degloving injury