A 57-year-old male presented to the Emergency Department with right elbow swelling and discomfort. The patient reported falling on the elbow and skidding on the grass with the elbow flexed forward while playing football, four days before presentation. While in the Emergency Department, the patient was seen by Orthopedics, had elbow radiographs performed (Fig. 1), and had approximately 5 cc of fluid (described as "venous blood") aspirated from the area of swelling.
The patient presented for a followup appointment at the Orthopedic Clinic two days later complaining of pain and increased swelling at the medial aspect of the elbow. The pain woke him from sleep and was only minimally relieved with pain medication. Additionally, there were two palpable cords in the region of elbow swelling. The patient was clinically diagnosed with traumatic bursitis, and a compressive bandage was applied. Over the next week, the patient's swelling worsened, and he had an ultrasound examination of the area of pain and palpable mass (Fig. 2).
On ultrasound, the mass showed lobules of increased echogenicity, interspersed with areas of slightly complex lower echogenicity. Unenhanced MRI, performed the following week, demonstrated an irregularly shaped, 4.2 x 3.7 x 1.4-cm (longitudinal x AP x transverse) lentiform unilocular T2 hyperintense collection that contained numerous fat globules overlying the deep fascia of the elbow and draping over the medial epicondyle (Figure 3, Figure 4).
The imaging findings were consistent with an acute MLL. The patient continued to follow up with Orthopedics over the course of the next few months, opting for conservative management, including physical therapy and pain medication. The collection resolved approximately 6 months after the traumatic event.