A Sister Mary Joseph nodule (SMJN) is a malignancy located in the periumbilical region. Often misinterpreted as a simple hernia, it is associated with advanced metastatic cancer. First reported in 1846, its primary sources include the gastrointestinal system and female reproductive sites. The most common origins include gastrointestinal (52%), gynecologic (28%), stomach (23%), and ovarian (16%). The presence of SMJN usually indicates widespread disease and is associated with a poor prognosis and complex therapeutic implications, with average patient survival of only 10 to 11 months after diagnosis. This report demonstrates the capability of sonography to evaluate soft tissue periumbilical masses, describes their sonographic appearance, and evaluates the utility of sonography to accurately locate the SMJN for biopsy.