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 finger nail.
These tumours should not be confused with paragangliomas, which are sometimes referred to as glomus tumour.
It classically presents in young to middle-aged (4th to 5th decades 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 finger nail and is exquisitely painful. Sometimes the pain is worse at night; it may disappear when a tourniquet is applied.
May also present as haemorrhage under the nail. The presence of the Hildreth sign (pain 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 harmatomas 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.
- the tumour 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 contrast enhancement (usually uniform) due to vascularity
- T2: high signal
Treatment and prognosis
Treatment is surgical resection.
General imaging differential considerations include:
- paraganglioma (also sometimes called glomus tumour)
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