case_images: PMC10758304_01
case_images: The patient's left big toe revealing an increased nail curvature up to the midline of the nail plate axis, leading to impingement of the midline periungual edge characterizing an onychogryphosis (red arrow).
case_images: cureus-0016-00000051482-i01.jpg
case_images: PMC10758304_01_cureus-0016-00000051482-i01.jpg
case_images: FIG1
case_images: The reason for consultation was progressive nail deformity (Figure 1), causing some esthetic discomfort to the patient and her family, which was why they decided to see a specialist (dermatologist), who requested auxiliary diagnostic tests (laboratories and imaging) to rule out or confirm an infectious process or glomus tumor. Physical examination revealed subungual bone injury to the distal extremity (distal phalanx of the left hallux) (Figure 1), with no other relevant findings.
case_images: Anteroposterior and lateral X-ray views of the left hallux, showing the injury.. (A) Anteroposterior X-ray of the left hallux, where we can observe an sclerotic image by superimposition; (B) Lateral X-ray of the left hallux, where we can observe an exophytic lesion with cortical and medullary continuity with the distal phalanx of the first toe.
case_images: cureus-0016-00000051482-i02.jpg
case_images: PMC10758304_01_cureus-0016-00000051482-i02.jpg
case_images: FIG2
case_images: To complete the examination requested by the dermatologist, and due to ultrasound findings on soft tissue, the imaging specialist requested an X-ray of the region (Figure 2) and referred the patient to a pediatric orthopedist for better management of the clinical picture.
case_images: Histopathological image showing intraosseous hemangiolymphangioma (H&E 100x).. (A) Dilated vascular structures replacing the bony medullary space. Arrow indicates flat endothelium consistent with lymphatic vessels.. (B) Polycystic pattern with several vascular structures delimited by thin, flat endothelium in bone marrow tissue. The arrow in one of the vessels indicates endothelium. This is consistent with lymphatic vascular structure.
case_images: cureus-0016-00000051482-i03.jpg
case_images: PMC10758304_01_cureus-0016-00000051482-i03.jpg
case_images: FIG3
case_images: After surgical removal, the resected specimen was sent for pathological assessment, in which it was found that an intraosseous hemangiolymphangioma was the origin of the tumor (Figure 3).