Elderly Woman With Abdominal Pain Minju Hwang, BS, Dhimitri A. Nikolla, DO, Frederick C. Havko, MD, Jestin N. Carlson, MD, MS  Annals of Emergency Medicine  Volume 71, Issue 3, (March 2018) DOI: 10.1016/j.annemergmed.2017.09.043 Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 1 Umbilical nodule on the abdomen. Annals of Emergency Medicine 2018 71, DOI: (10.1016/j.annemergmed.2017.09.043) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 2 Close-up photograph of the abdomen, showing the umbilical nodule. Annals of Emergency Medicine 2018 71, DOI: (10.1016/j.annemergmed.2017.09.043) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 3 CT of the abdomen and pelvis (axial view), showing a hepatic defect concerning for a mass (black arrow), calcified granulomas of the spleen (arrowhead), and free air (white arrows). Annals of Emergency Medicine 2018 71, DOI: (10.1016/j.annemergmed.2017.09.043) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 4 CT of the abdomen and pelvis (axial view), showing a density left of the colon concerning for a mass (asterisk); thickening of the rectosigmoid colon, thought to be the site of hollow viscus perforation with surrounding adenopathy (black arrow); and nodular thickening along the anterior intraperitoneal fat suspicious for peritoneal-based metastatic disease (white arrow). Annals of Emergency Medicine 2018 71, DOI: (10.1016/j.annemergmed.2017.09.043) Copyright © 2017 American College of Emergency Physicians Terms and Conditions