Glomangioma

Dr Henry Knipe and A.Prof Frank Gaillard et al.

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

These tumors should not be confused with paragangliomas, which are sometimes also referred to as glomus tumors. 

It classically presents in young to middle-aged (4th to 5th decades 7). There is a recognized female predilection. They can be multiple in ~ 10% of cases. Glomus tumors account for 1-5% of the soft-tissue tumors in the hand 4.

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

May also present as hemorrhage 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 tumors originate from the neuromyoarterial plexus: modified smooth muscle cells of the glomus body. They are best thought of as hamartomas rather than true tumors. There are two main components on microscopy:

  • branching vascular channels
  • aggregates of specialized glomus cells

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

  • the tumor is difficult if not impossible to identify, 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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Article information

rID: 1390
Synonyms or Alternate Spellings:
  • Glomangioma (glomus tumour)
  • Subungual glomus tumour
  • Subungual glomus tumor
  • Glomangiomas
  • Subungual glomus tumors
  • Subungual glomus tumours
  • Tumors of Popoff
  • Barré-Masson syndrome
  • Tumours of Popoff
  • Glomus tumours of the bone
  • Glomus tumours of bone

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Cases and figures

  • Case 1: on plain film
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  • Case 1: on MRI
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  • Case 2: slightly atypical (on volar aspect)
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6: around the knee
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  • Case 7
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