Double duct sign

Changed by Mostafa Elfeky, 27 Jan 2023

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Disclosures - updated 11 May 2022: Nothing to disclose

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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~~(ERCP). In general, the double duct sign represents a malignant cause until disproved.

Pathology

Aetiology

Common

Less common

malignant
- cholangiocarcinoma ~~of the CBD~~ involving distal common bile duct
- lymphoma
- ampullary metastases
impacted gallstone in distal duct, with associated oedema, resulting in pancreatic duct obstruction
chronic pancreatitis
ampullary stenosis

Rare

Case reports ^1-3

-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). In general, the double duct sign represents a malignant cause until disproved.<h4>Pathology</h4><h5>Aetiology</h5>Common<ul>
~~-<li><a href="/articles/pancreatic-ductal-adenocarcinoma-4">carcinoma of the head of the pancreas</a></li>~~
~~-<li>~~
~~-<a href="/articles/ampullary-tumour">ampullary tumours </a>(e.g. <a href="/articles/ampullary-adenocarcinoma">carcinoma of the ampulla of Vater</a>)</li>~~
~~-</ul>Less common<ul>~~
~~-<li>malignant<ul>~~
~~-<li>cholangiocarcinoma of the CBD</li>~~
~~-<li>lymphoma</li>~~
~~-<li>metastases</li>~~
~~-</ul>~~
~~-</li>~~
~~-<li>~~
~~-<a href="/articles/choledocholithiasis">impacted gallstone in distal duct</a>, with associated oedema, resulting in pancreatic duct obstruction</li>~~
~~-<li><a href="/articles/chronic-pancreatitis-2">chronic pancreatitis</a></li>~~
~~-<li>ampullary stenosis</li>~~
~~-</ul>RareCase reports 1-3<ul>~~
~~-<li><a href="/articles/idiopathic-retroperitoneal-fibrosis">primary retroperitoneal fibrosis</a></li>~~
~~-<li><a href="/articles/kaposi-sarcoma">Kaposi sarcoma</a></li>~~
~~-<li>~~
~~-<a href="/articles/sphincter-of-oddi-dysfunction">sphincter of Oddi dysfunction</a> 3~~
~~-</li>~~
+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 (<a href="/articles/endoscopic-retrograde-cholangiopancreatography" title="ERCP">ERCP</a>). In general, the double duct sign represents a malignant cause until disproved.<h4>Pathology</h4><h5>Aetiology</h5>Common<ul>
+<li><a href="/articles/pancreatic-ductal-adenocarcinoma-4">carcinoma of the head of the pancreas</a></li>
+<li><a href="/articles/ampullary-tumour">ampullary tumours </a>(e.g. <a href="/articles/ampullary-adenocarcinoma">carcinoma of the ampulla of Vater</a>)</li>
+</ul>Less common<ul>
+<li>
+malignant
+<ul>
+<li><a href="/articles/cholangiocarcinoma" title="Cholangiocarcinoma">cholangiocarcinoma</a> involving distal common bile duct</li>
+<li>lymphoma</li>
+<li><a href="/articles/ampullary-metastases" title="ampullary metastases">ampullary metastases</a></li>
+</ul>
+</li>
+<li><a href="/articles/choledocholithiasis">impacted gallstone in distal duct</a>, with associated oedema, resulting in pancreatic duct obstruction</li>
+<li><a href="/articles/chronic-pancreatitis-2">chronic pancreatitis</a></li>
+<li><a href="/articles/ampullary-stenosis" title="ampullary stenosis">ampullary stenosis</a></li>
+</ul>RareCase reports 1-3<ul>
+<li><a href="/articles/idiopathic-retroperitoneal-fibrosis">primary retroperitoneal fibrosis</a></li>
+<li><a href="/articles/kaposi-sarcoma">Kaposi sarcoma</a></li>
+<li><a href="/articles/sphincter-of-oddi-dysfunction">sphincter of Oddi dysfunction</a> 3</li>

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Double duct sign

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