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DIAGNOSIS:

Glomus tumor/Glomagioma nail bed
[Description: An intensely enhancing ovoid lesion is seen within the nailbed with otherwise normal subjacent bone]

Glomus tumours of the nail bed [glomangiomas], are benign vascular tumours or  more rightly hamartomas, arising from the glomus body [arteriovenous shunts for temperature regualtion] in the dermis. They are most often seen in fingers in a subungual location. They are very small in size between 2 to 7mm and hence very difficult to diagnose both clinically as well as on routine imaging like plain radiography/CT. USG often shows the lesion well with its high vascularity but requires great expertise.

MRI is the most preferred modality for diagnosing these lesions. MRI not only confirms the diagnosis but also localises the lesion to direct appropriate surgical plan. It also helps in differentiating from the other lesions like epidermal inclusion cysts, mucous cysts and giant cell tumors of the tendon sheath.

The differentiation is very accurate with dynamic contrast enhanced MRI which shows the characterisitc intense arterial phase enhancing nidus, typical of a glomus tumor. The lesion otherwise shows low to medium intensity signal on T1 weighted images and high signal intensity on T2 weighted images, essentially the same as others tumors in this region. In long standing cases erosions and edema of the subjacent bone may be seen.
 
While glomus tumors are benign lesions, diagnosis is important because of the excruciating pain caused by them and the gratifying response to surgery.

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