Online First
Clinical Images  |   September 2020
Sister Mary Joseph Nodule
Author Notes
  • From the Department of Internal Medicine at John H. Stroger, Jr. Hospital of Cook County in Chicago, Illinois. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Parth Desai, DO, John H. Stroger, Jr. Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612-3765. Email: parth.desai@cookcountyhhs.org
     
Article Information
Emergency Medicine / Gastroenterology / Imaging / Obstetrics and Gynecology / Ophthalmology and Otolaryngology / Pulmonary Disorders
Clinical Images   |   September 2020
Sister Mary Joseph Nodule
The Journal of the American Osteopathic Association Published Online First on September 23, 2020. doi:https://doi.org/10.7556/jaoa.2020.131
The Journal of the American Osteopathic Association Published Online First on September 23, 2020. doi:https://doi.org/10.7556/jaoa.2020.131
A 59-year-old woman with ductal carcinoma in situ status post-bilateral mastectomy presented to the emergency department with two weeks of jaundice. Vital signs were normal and examination revealed marked scleral icterus, jaundice, and a palpable subcutaneous umbilical nodule. Laboratory investigation revealed direct hyperbilirubinemia with direct bilirubin of 16.2 mg/dL (Ref: 0-0.2 mg/dL), total bilirubin of 22.3 mg/dL (Ref: 0.2-1.2 mg/dL), and alkaline phosphatase 323 U/L (Ref: 20-120 U/L). Contrast enhanced abdominal computed tomography scan demonstrated thickening and fat stranding of the gallbladder neck, concomitant intrahepatic biliary ductal dilatation, and an umbilical soft tissue deposit (image A and image B). Endoscopic retrograde cholangiopancreatography with common bile duct brushings revealed gallbladder adenocarcinoma. The patient was not a candidate for chemotherapy and died during the hospitalization from septic shock due to a bilioma and ARDS. 

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