An elderly man with chronic poor appetite

Clinical introduction A 77-year-old man with a 6-month history of poor appetite, nausea, weakness, and progressive weight loss presented to our outpatient department. He had no significant gastrointestinal or cardiovascular problems. Abdominal findings are pictured in figure 1. Question What is the most likely diagnosis? Omphalitis Umbilical abscess Urachal remnant Umbilical metastasis (Sister Mary Joseph’s nodule) Answer: D His abdominal findings showed conjunctival pallor and a firm, painless, blackish nodule on the umbilicus suggestive as umbilical metastasis (figure 2). Umbilical metastasis, also called Sister Mary Joseph’s nodule, presents as a painless, blackish nodule and is histologically an adenocarcinoma. It is typically associated with gastrointestinal or gynaecological malignancies, although in 15%–20% of cases, the primary site of malignancy remains unknown.1 In this case, the mechanisms of umbilical metastasis are including bloodstream, lymphatic, direct peritoneal spread...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research