Skin ultrasound of distrophic glomic nail tumor.

Nail unit is a complex structure in which skin ultrasound is a really helpful tool due to:

1. Clear location of offending lesion in nail ( matrix, lateral folds, nail bed).
2. Ultrasonographic features of lesion are suggestive of  lesion  diagnosis.
3. Surgical planning is possible preoperatively.

I would like  to illustrate this with a case I treated in Hospital Puerta de Hierro (Madrid).

CASE

• 45-year-old woman
• No relevant antecedents
• Painful distrpohic nail  lesion for 3 years

Diagnostic preoperative ultrasound was performed

 US IMAGES

 Color doppler

Pulsed doppler arterial spectrum

ULTRASOUND REPORT

In proximal fold a hypoechoic oval lesion laying on nail matrix area is evident. Color and spectral Doppler show arterial flow in this lesion

EVOLUTION

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

DIAGNOSIS

Digital glomus tumor

TAKE HOME MESSAGES

1. Glomus tumor is relatively frequent and usually underdiagnosed.
2. Ultrasound of glomus tumor is really useful in presumptive diagnosis.
3. Extradigital glomus tumor exist and are even more underdiagnosed!!!
4. Minimally invasive approach requires preoperative surgical planning.
5. 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.