Even in patients who initially present immediately after the onset of injury with no symptoms, it is necessary to perform a VS-4718 cell line follow-up physical examination and imaging studies. This is essential for the identification of delayed lesion development. When children and adults are subjected to blunt trauma of the

same width, children are vulnerable see more to higher shock per unit area. It can therefore be inferred not only that children are more vulnerable to developing multiple organ damage due to MLL but also that they are at increased risk of developing fractures or deep organ injuries due to the incomplete development of their musculoskeletal systems. Moreover, children have a relative lack of the shock-absorbing function due to the incomplete development of subcutaneous fat [39]. It can therefore be inferred that

pediatric cases of MLL might lead to severe degloving injuries. Furthermore, due to their lower volume of blood, children are vulnerable to hypovolemic shock due to bleeding as well as to skin necrosis due to an abrupt mass effect SBE-��-CD arising from the collection of internal bleeding in the dead space. Such children should be promptly treated immediately after being diagnosed with MLL. Conclusions MLL is a collection of hemolymph resulting from a closed degloving injury. Its diagnosis and treatment are often delayed because it involves internal degloving without surface penetration. Diagnosis of MLL can be made based on clinical and radiological examination. A number of treatment modalities, ranging from conservative management to open debridement, can be attempted for patients with MLL. However, there are no established case-specific

treatment regimens for patients with MLL. Although rare, pediatric cases of MLL deserve special attention. This is true not only because MLL in children may pose a diagnostic challenge due to possible difficulties in determining whether there is a past history of shearing injury but also because MLL in children is associated with an increased frequency of fatal complications compared to MLL in adults. Clinicians should therefore include very MLL in the differential diagnosis of patients with trauma, even in the absence of a past history of shearing injury. Moreover, clinicians should also perform both physical examinations and imaging studies in establishing a diagnosis of MLL in children. Consent Written informed consent was obtained from the patient for publication of this case report and the accompanying images. References 1. Kalaci A, Karazincir S, Yanat AN: Long-standing morel-lavallee lesion of the thigh simulating a neoplasm. Clin Imaging 2007, 31:287–291.PubMedCrossRef 2.