Subungual angioleiomyoma masquerading as a glomus tumour

S ir, A 69‐year‐old housewife presented with a complaint of nail bed–nail plate separation of the right index finger of 10 years duration. Only the lunula region was spared; the extensive onycholysis was accompanied by tenderness of the distal digit. The association of pain, maximum tenderness at the base of the nail and sensitivity to cold led to the obvious diagnosis of glomus tumour. The pin test, in which pressure by the head of a pin is used to localize a tumour, was precluded because of excruciating pain. X‐ray examination did not show any erosion of the terminal phalanx. Because of the absence of positive findings a magnetic resonance imaging (MRI) scan was carried out. Axial images depicted a well‐circumscribed 4‐mm nodule in the nail bed, beneath the distal matrix. The tumour occupied the whole thickness of the ulnar part of the distal matrix and led to a deep erosion of the cortex of the distal phalanx. The signal was rather homogeneous and non‐specific (somewhat dense on T1‐weighted images and strongly dense on T2‐weighted images). The vascular behaviour was proved by a strong enhancement on postcontrast images.