Introduction Morel-Lavallée syndrome (MLS) is considered as a rare entity and hemorrhagic shock as a complication is uncommon. Presentation of case We report the case of a 56-year- old man who presented to the emergency department after a road traffic accident. Initially, the patient was hemodynamically unstable (heart rate 160 beats/min and blood pressure 65/30). Physical examination revealed multiple lacerations on his back and a gradually expanding large subcutaneous hematoma on the left flank extending to the hip and left leg. Fluid resuscitation was rapidly initiated. After stabilizing his hemodynamic status, a full-body computed tomography was performed revealing, apart from a small unilateral pneumothorax and a stable pelvis fracture, an extensive Morel-Lavallée lesion in the lumbar region extending to the hip and both legs. The patient was then transferred to a surgical intensive care unit for further resuscitation and surgical drainage of the collection followed by continuous suction was performed. Even though rare, Hemorrhagic shock is one of the threatening complications of Morel-Lavallée lesions and should be kept in mind by every traumatologist and emergency doctor. Conclusion We report a case about a rare complication of MLS which is hemorrhagic shock in order to highlight the importance of making the diagnosis, which can be unrecognized, and initiate an adequate treatment on time.

Background: For the diagnosis of acute pulmonary embolism, chest computerized tomography (CT) angiography is considered as the gold standard. However, echocardiography could be useful especially in cases of high suspicion with normal CT scan or for patient with hemodynamic instability. Case presentation: We present a case of a 47-year-old man admitted to the intensive care unit with a diagnosis of respiratory failure and hemodynamic instability 24 hours after closed fracture of the right leg. Before his admission, a thoracic CT angiography was done but did not show any sign of acute pulmonary embolism. During the first hours, he presented a bad evolution with a respiratory status which failed to respond to high dose of vasopressor, oxide nitric and ventilatory support. Therefore, due to the poor echocardiographic window, transesophageal echocardiography examination was done in emergency. It revealed high-probability diagnosis of massive pulmonary embolism based on right ventricular dysfunction and the presence of thrombus in the right pulmonary artery. Anticoagulant therapy (non-fractioned heparin) was administrated immediately achieving a favorable clinical outcome with rapid withdrawal of dobutamine, nitric oxide and norepinephrine. Conclusions: This case illustrates the fundamental role of transesophageal echocardiography in a critically ill patient with shock due to high-probability pulmonary embolism. Echocardiography allows the initiation of adequate treatment without further delay.

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