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Double duct sign

Case contributed by Mohammad Taghi Niknejad
Diagnosis certain


Abdominal pain.

Patient Data

Age: 85 years
Gender: Female

Intra and extrahepatic bile ducts are dilated and CBD measured 15 mm in caliber. The pancreatic duct is also dilated demonstrates double duct sign.

Several thin-walled non-enhancing cysts are seen in the pancreas less than 30 mm. 

A 110×85 mm thin-walled cyst is present in the midline pelvis without an obvious enhancing solid component. The right ovary couldn’t be defined separately from the mentioned cyst. 

Case Discussion

The double duct sign refers to the presence of simultaneous dilatation of the common bile and pancreatic ducts. Carcinoma of the head of the pancreas and ampullary tumors are the most common causes, although occasionally an impacted stone in the distal common bile duct can also result in double duct sign.

The patient underwent ERCP and a biopsy of the subtle ampullary lesion was performed. The histopathologic evaluation confirms it to be an ampullary adenocarcinoma.

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