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Double duct sign

The double duct sign refers to the presence of simultaneous dilatation of the common bile and pancreatic ducts. Being an anatomical sign it can be seen on all modalities that can visualise the region, including : MRI, CT, ultrasound and endoscopic retrograde  cholangiopancreatography (ERCP). 

The two most common causes of the double duct sign are carcinoma of the head of the pancreas and ampullary tumours (e.g. carcinoma of the ampulla of Vater), although occasionally an impacted gall stone in the distal duct, with associated oedema, can also result in obstruction of the pancreatic duct. 

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