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.
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Terminology
These tumors should not be confused with paragangliomas, which are sometimes also referred to as glomus tumors.
Epidemiology
They classically present in the young to middle-aged (40 to 50 years of age) population 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.
Clinical presentation
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 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.
Pathology
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
Location
Approximately 75% occur in the hand 4; a subungual position is characteristic.
Radiographic features
Plain radiograph
the tumor 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
Ultrasound
subungual hypoechoic nodular lesion at the region of maximum tenderness
hypervascularity on Doppler tends to be prominent
MRI
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 and prognosis
Treatment is surgical resection.
Differential diagnosis
General imaging differential considerations include:
angioleiomyomas
See also
paraganglioma (also sometimes called glomus tumor)
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