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

Published:December 30, 2019DOI:


      • 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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Yendluri V, Centeno B, Springett GM. Pancreatic cancer presenting as a Sister Mary Joseph's nodule: case report and update of the literature. Pancreas. 2007 Jan; 34(1):161–4. doi:

        • Abu-Hilal M.
        • Newman J.S.
        Sister Mary Joseph and her nodule: historical and clinical perspective.
        Am J Med Sci. 2009 Apr; 337: 271-273
        • Piura B.
        • Meirovitz M.
        • Bayme M.
        • Shaco-Levy R.
        Sister Mary Joseph’s nodule originating from endometrial carcinoma incidentally detected during surgery for an umbilical hernia: a case report.
        Arch Gynecol Obstet. 2006; 274: 385-388
        • Majmudar B.
        • Wiskind A.K.
        • Croft B.N.
        • Dudley A.G.
        The Sister (Mary) Joseph nodule: its significance in gynecology.
        Gynecol Oncol. 1991 Feb; 40: 152-159
        • Tokai H.
        • Matsuo S.
        • Azuma T.
        • Haraguchi M.
        • Yamaguchi S.
        • Kanematsu T.
        Pancreatic cancer with umbilical metastasis (Sister Mary Joseph’s nodule).
        Acta Med Nagasaki. 2005; 50 ([doi:10.3748/wjg.v18.i45.6686]): 123-126
        • Ching A.S.
        • Lai C.W.
        Sonography of umbilical metastasis (Sister Mary Joseph’s nodule): from embryology to imaging.
        Abdom Imaging. 2002; 27: 746-749
        • Wronski M.
        • Klucinski A.
        • Krasnodebski I.W.
        Sister Mary Joseph nodule: a tip of an iceberg.
        J Ultrasound Med. 2014; 33: 531-534
        • Barrow M.V.
        Metastatic tumors of the umbilicus.
        J Chronic Dis. 1966 Oct; 19: 1113-1117
        • Palaniappan M.
        • Jose W.M.
        • Mehta A.
        • Kumar K.
        • Pavithran K.
        Umbilical metastasis: a case series of four Sister Joseph nodules from four different visceral malignancies.
        Curr Oncol. 2010 Nov; 17: 78-81
        • Métivier D.
        • Bonardel G.
        • Rouquie D.
        • Gontier E.
        • Chargari C.
        • Dechaud C.
        18F-FDG PET/CT imaging of Sister Mary Joseph’s nodule.
        Clin Nucl Med. 2012; 37: 486-488