Last revised by Ciléin Kearns on 12 May 2024

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 were formerly known as glomus tumors. 

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.

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.

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

Glomus tumors are positive for SMA, MSA, calponin, h-caldesmon, and collagen type IV. They are negative for cytokeratin and S100. MIR143-NOTCH gene fusions are present in more than half of glomus tumors 8.

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

  • 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

  • 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:

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.