Double duct sign; ERCP is needed for more evaluation.

The double duct sign refers to the presence of simultaneous dilatation of the common bile and pancreatic ducts. The two most common causes of the double duct sign are carcinoma of the head of the pancreas and ampullary tumors , although occasionally an impacted gallstone in the distal duct, with associated edema, can also result in obstruction of the pancreatic duct.