Evaluation Of Thrombocytopenia In The Pediatric Patients By Platelet Indices: A Study In A Tertiary Care Hospital.

Background: Evaluation of thrombocytopenia involves a meticulous approach in which complete clinical history, clinical examination, complete hemogram and bone marrow aspiration if indicated, are included. The various platelet indices produced by the automated analysers such as, Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT) and Large cell ratio (LCR) can be used to distinguish the underlying etiology of thrombocytopenia. Methods: Total of seventy three thrombocytopenic patients <14 years with proper clinic-hematological work up were included in the study. The results were compared by manual examination of the peripheral blood smear. Results: Patients were grouped based on the mechanism- Peripheral destruction 54 (73.9%), Hypoproduction 10 (13.6%), Hypersplenism 9 (12.3%). There was a linear correlation between the platelet count and all the platelet derived indices (MPV, PDW, PCT, LCR) in the patients with peripheral destruction of platelets.The p-value of all the derivatives was statistically significant (level of significance less than 0.05). In patients with hypoproduction and hypersplenism,there was positive correlation between the platelet count and MPV, PDW, PCT & LCR. None of the pvalues were statistically significant. Conclusions: Platelet indices especially MPV and PDW can be used as important initial and supportive tool to differentiate between the hyperdestructive versus hypoprodution and hypersplenism cases.

Morel-Lavallee Lesion Of Lumbar Region

Morel-Lavallee lesion is a closed degloving injury characterized by post-traumatic separation of subcutaneous fat plane form underlying fascia, & thus created potential space being filled by fluid & debris of varying nature. Though originally described in the thigh, it has also been described in other anatomical sites including lumbar region. The lesion usually presents as compressible/fluctuant swelling at traumatic site. Most of patients present few days to few weeks after injury. However, patients with ignored slow growing painless lesions may present with long standing mass like lesions which may need open surgical intervention. Here, we present a case of long standing Morel-Lavallee lesion of lumbar region in a patient from remote village.

Extensive Multiple Morel-Lavallée Lesions: A Case Report

Morel-Lavallée is a rare lesion caused by post-traumatic soft tissue injury. It usually occurs around the greater trochanter, and it occurs very rarely in the lumbar region. It is often difficult to be diagnosed in the emergency room. Delayed diagnosis may result in the need for open surgery. The authors report a patient with extensive multiple Morel-Lavallée lesions in the thoracolumbar, buttock, and thigh after trauma and provide a literature review.

Percutaneous Drainage and Sclerotherapy for Delayed Lumbar Morel-Lavalee Lesion: Two Case Reports

Closed internal degloving is a significant soft-tissue injury associated with a trauma that results in a tear of the subcutaneous tissue away from the underlying fascia. Although the diagnosis of Morel-Lavallee lesion (MLL) is routinely based on clinical and radiological examinations, in one-third of the cases, there is a possibility that clinicians may fail to diagnose MLL due to its inconsistent clinical manifestations. Additionally, it often involves initial skin bruising due to underlying soft-tissue injury. We present two cases of delayed MLL without a fracture treated using percutaneous drainage and sclerotherapy. Our cases demonstrated successful treatment with a minimally invasive percutaneous approach. The potential advantage of using a percutaneous technique is to preserve the subdermal arterial plexus, which is the only remaining blood supply to the skin in the area of the lesion. Maintaining this blood supply may result in healthier skin at the time of any open procedure.

Clinics in diagnostic imaging (164). Morel-Lavallée lesion

A 31-year-old male motorcyclist presented with prepatellar swelling of the left knee after a collision with a car. Magnetic resonance imaging of the knee showed no bony or ligamentous injury to the knee. Instead, a well-defined, thin-walled, T2-weighted hyperintense fluid collection with internal septations was identified in a prefascial location overlying the left patella and patellar tendon. The findings were in keeping with those of a Morel-Lavallée lesion, a closed internal degloving injury. Morel-Lavallée lesions are occasionally encountered after a blunt soft-tissue trauma. The presentation and imaging features are discussed.

Sonographic Findings of Morel-Lavallee Lesions

PURPOSE: We reviewed the sonographic features of Morel-Lavallee lesions by correlating the US image findings with a lesion's age. MATERIALS AND METHODS: We obtained the sonography reports of 20 Morel-Lavallee lesions of the hip and extremities from 18 patients with a history of trauma. The US images were reviewed to characterize the echogenicity, shape, homogeneity, margins, location and size of the lesions. The results were correlated with the age of the lesions and the clinical histories. RESULTS: All the Morel-Lavallee lesions were hypoechoic or anechoic fluid collections located between the subcutaneous fat and the underlying fascia. Regarding the shape of the fluid collections, the lobular shaped lesions were all less than 21 days for the lesion's age, and the flat fluid collections were all greater than 1 month of age. Regarding the homogeneity, the heterogeneous fluid collections were all less than 25 days of age, and the homogeneous fluid collections were all greater than 1 month of age. CONCLUSION: A Morel-Lavallee lesion is seen as a posttraumatic fluid collection in the potential space between the subcutaneous fat and the underlying fascia on an ultrasound examination. Acute Morel-Lavallee lesions tended to be heterogeneous and lobular, and they became more homogeneous and flat in shape as the lesions evolved. Awareness of these imaging findings will help us to properly diagnose Morel-Lavallee lesions.

Morel-Lavallee Lesion: A Case Report

PURPOSE: Morel-Lavallee lesions is post-traumatic effusion at subcutaneous layer. Early management of Morel-Lavallee lesion is percutaneous drainage and compression. Surgical excision is recommended for cases that are chronic. METHODS: A 41-year old male patient had slow growing, painful mass on left thigh, which has been present for 3 years. He had a history of blunt trauma 3 years ago. Computed tomography presented 10 x 10 x 5 cm sized cystic mass on left thigh, between subcutaneous fat layer and muscle fascia layer. The mass was surgically removed and biopsy was performed. RESULTS: Histopathological examination shows chronic inflammation and fibrotic change. After 6 month follow-up period, postoperative course was uneventful. CONCLUSION: We performed surgical excision of Morel-Lavalle lesion in a patient who had trauma 3 years ago. We report a case of Morel-Lavallee lesion with the review of the literatures.