The Lunula: An ultrasound imaging approach

The lunula is the white, half-moon-shaped area seen on some, but not all nails. Usually the lunula is the topographic marker of the distal part of the nail matrix, and known to have the ability of nail production. Ultrasonographic imaging of the lunula has not been reported before. This study was undertaken to demonstrate normal ultrasonographic features of the lunula. Ultrasonographic examination of the lunula was performed in the right thumb of 20 healthy volunteers (10M, 10F, mean age 30, range 26-36 years) with a real-time, high-resolution ultrasound unit (Sequoia 512, Acuson, Mountain view, CA, USA) with 8-15 MHz linear transducers. Gray scale color, and special Doppler imagings were performed with longitudinal scanning. The lunula was not seen inspection in three of the 20 volunteers. The mean size of the lunula in the other 17 volumteen was 3.31 ± 1.24 mm (range 2-6.2 mm). Gray scale ultrasound imaging showed the lunula; ovoid shaped hypo-echoic zone in proximal fingernail in 18 of 20 volunteers (mean size, 6.74 ± 0.98 mm, range 5-8.8 mm). In two of 20 volunteers, the lunula was indistinct on gray scale ultrasound examination. However, all lunula were identifiable on color Doppler imaging by detecting vascularity within the lunula. Spectral wave pattern of the lunula was a bi-directional pulsatile wave. Peak velocity was within 5-15 m/sec (mean 8 m/sec). The lunula is identifiable on ultrasound examination as a hyper-vascular, ovoid shaped, hypo-echoic zone in proximal fingernail. This normal structure should not be misinterpreted as an abnormal sub-ungual lesion.