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Sister Mary Joseph nodule: an often overlooked or misdiagnosed entity on imaging

Published:December 30, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.12.017

      Highlights

      • In a patient with an intra-abdominal malignancy presenting with umbilical pain, SMJN should be part of a tailored search pattern.
      • The umbilical region is a site of metastasis due to the convergence of multiple ligaments and rich lymphatic/blood supply.
      • CT features of SMJN include a highly vascular, solid, hyperdense, contrast-enhancing nodule within the subcutaneous tissues.
      • Identification of Sister Mary Joseph nodules is essential to determining staging and course of further treatment in a malignancy.

      Abstract

      Sister Mary Joseph nodule (SMJN) is an umbilical nodule representing a metastatic deposit from an intra-abdominal primary malignancy. Most radiologists are unaware of this phenomenon, and cases of SMJN have rarely been described in the radiology literature, to our knowledge. We present an example of a patient with known primary pancreatic adenocarcinoma found to have an umbilical nodule as the first manifestation of metastatic disease after an initial misdiagnosis on computed tomography. In addition, we delineate the importance of maintaining a high index of suspicion and pattern recognition for SMJN during imaging when a patient presents with umbilical pain in the setting of known malignancy, since early diagnosis can alter management.

      Keywords

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