Double duct sign

Case contributed by Mohammadtaghi Niknejad

Presentation

Abdominal pain and elevated liver enzymes.

Patient Data

Age: 75 years
Gender: Male
mri

The gallbladder is not seen at the anatomical location due to prior resection.

Intra and extra hepatic bile ducts are dilated, and CBD measured 17 mm in caliber with homogenous internal signal intensity and distal abrupt cutoff. The pancreatic duct is also dilated. (Double duct sign)

A 15 mm low signal mass like filling defect is evident at the distal of CBD.

Case Discussion

The patient underwent ERCP and biopsy, and histopathology evaluation confirmed ampullary adenocarcinoma which is a rare biliary tumor arising from the distal biliary epithelium at the ampulla of Vater

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