A 38-year-old female patient with bluish discoloration of left middle fingernail is presented. She complained of intense pain in this distinctive blue to purple discoloured area. Pin-point tenderness and onychoscopic changes suggested a nail bed glomus tumor. High frequency ultrasound revealed a 5.8 × 3.9 cm hypoechoic lesion on the radial aspect with increased vascularity. Magnetic resonance T1-weighted images showed an isointense lesion with intense contrast enhancement. A diagnosis of glomus tumor was confirmed and surgical excision was offered. A transungual excision, after proximal partial nail avulsion revealed a well-defined tumour (6 × 4 mm) with an irregular surface. Primary closure of the nail bed defect with nail plate repositioning was done. Histopathology of the excised specimen confirmed the diagnosis. An uneventful post-operative recovery with no residual pain, discoloration, or onycholysis was seen. The case is reported to outline the diagnostic and therapeutic approach and discuss possible differential diagnoses.