Volar fingertip glomus tumors: Diagnostic challenges and targeted ultrasonography

Volar glomus tumors of the fingertip are uncommon and may be overlooked when classic subungual signs are absent. We report 2 women with 4-year histories of severe pinpoint volar pulp pain and cold hypersensitivity, normal radiographs, and no nail changes. Targeted high-resolution ultrasonography at the point of maximal tenderness identified small hyper-vascular hypoechoic nodules in both cases. Magnetic resonance imaging characterized the lesion in 1 case but was nondiagnostic in the other. Both patients underwent complete excision with immediate symptom relief and sustained resolution at 6 months. These cases emphasize that a nondiagnostic MRI should not exclude glomus tumor when clinical suspicion remains high, and that targeted ultrasonography may be a useful adjunct for localization in small volar fingertip lesions.