Glomangioma

Last revised by Mostafa Elfeky on 25 Oct 2023

Glomangiomas, also known as glomus tumours, are benign vascular tumours typically seen at the distal extremities. On imaging, they characteristically present as small hypervascular nodules under the fingernail. 

These tumours should not be confused with paragangliomas, which were formerly known as glomus tumours. 

They classically present in the young to middle-aged (40 to 50 years of age) population 7. There is a recognised female predilection. They can be multiple in ~10% of cases. Glomus tumours account for 1-5% of the soft-tissue tumours in the hand 4.

The lesion usually presents as a small firm red-blue nodule under the fingernail and is exquisitely painful and sensitive to cold temperature and touch. Sometimes the pain is worse at night; it may disappear when a tourniquet is applied.

It may also present as haemorrhage under the nail. The presence of the Hildreth sign (pain relief following the application of a tourniquet proximally) is considered pathognomonic on clinical grounds 7.

Glomus tumours originate from the neuromyoarterial plexus (modified smooth muscle cells of the glomus body). They are best thought of as hamartomas rather than true tumours. There are two main components on microscopy:

  • branching vascular channels

  • aggregates of specialised glomus cells

Approximately 75% occur in the hand 4; a subungual position is characteristic.

  • the tumour is difficult if not impossible to identify, and rarely can be seen as a subtle soft tissue density

  • may show a marginated osseous erosion or thinning of the adjacent cortical bone

  • subungual hypoechoic nodular lesion at the region of maximum tenderness

  • hypervascularity on Doppler tends to be prominent

Signal characteristics include:

  • T1: low to intermediate signal

  • T1 C+ (Gd): shows avid contrast enhancement (usually uniform) due to high vascularity

  • T2: intense high signal 

Treatment is surgical resection.

General imaging differential considerations include:

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