Ampullary tumor

Case contributed by David Cuete
Diagnosis almost certain


Obstructive jaundice

Patient Data

Age: 50 years
Gender: Female

There is an irregular hypovascular mass in ampulla with associated marked dilatation of common and intrahepactic bile ducts. The pancreatic duct is not dilated. No upstream pancreatic atrophy. 

Normal fat planes preserved around major abdominal aortic branches. 

No lymphadenopathy. 

Case Discussion

This case shows a lesion of the ampulla of Vater however the double duct sign is not displayed. This sign, seen in the majority of tumors of the ampulla of Vater, consists of a dilated pancreatic duct and common bile duct at the same time.  A normal-sized pancreatic duct does not however exclude the diagnosis of ampullary neoplasm because the ductal caliber will be normal in up to 50% in patients with bile duct obstruction caused by an ampullary tumor.

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