Nail unit is a complex structure in which skin ultrasound is a really helpful tool due to:
- Clear location of offending lesion in nail ( matrix, lateral folds, nail bed).
- Ultrasonographic features of lesion are suggestive of lesion diagnosis.
- Surgical planning is possible preoperatively.
I would like to illustrate this with a case I treated in Hospital Puerta de Hierro (Madrid).
- 45-year-old woman
- No relevant antecedents
- Painful distrpohic nail lesion for 3 years
Diagnostic preoperative ultrasound was performed
Pulsed doppler arterial spectrum
In proximal fold a hypoechoic oval lesion laying on nail matrix area is evident. Color and spectral Doppler show arterial flow in this lesion
The patient was operated with a minimally invasive approach ( limited incision in proximal fold) immediately pain was eliminated and we are waiting for nail regrowth normalization of nail plate
Digital glomus tumor
TAKE HOME MESSAGES
- Glomus tumor is relatively frequent and usually underdiagnosed.
- Ultrasound of glomus tumor is really useful in presumptive diagnosis.
- Extradigital glomus tumor exist and are even more underdiagnosed!!!
- Minimally invasive approach requires preoperative surgical planning.
- Skin ultrasound is ideal non invasive test if facing possible glomus tumor.
A course on Nail medicine and Surgery will be hold in Hospital de Fuenlabrada next May 29th 2013. There will be a talk about role of skin ultrasound in nail surgery.