Double duct sign

1. DOUBLE DUCT SIGN Dilatation of both CBD and PANCREATIC DUCT is appreciated in the mentioned sign and there is very high probability of malignant Etiology ( ? Periampullary carcinoma ? Ca head of pancreas) . There is encasement of both the ducts with tight stricture , irregular outline leading to narrowing of the ducts. MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

2. PRESENT CASE The radiological findings are supportive of Mitotic lesion in the ampullary / periampullary region (? Periampullary carcinoma) owing to following observations: Double duct sign Mural thickening along distal CBD. Tight stricture and abrupt cut off of choledochus . Irregularity and altered MR signal in the ampullary / periampullary region with bulge into the duodenal lumen from the medial wall . IMPORTANT NEGATIVE FINDINGS ARE : No meniscus sign appreciated in distal part of choledochus . ( c/f calculus) The ramifications of the pancreatic duct are not dilated .(c/f infective etiology ) IN ADDITION : Cholecystomegaly and cholelithiasis appreciated. Clinical profile : 70 YR OLD MALE Left kidney –post op status. Obstructive jaundice: ( ? VIRAL ? EHO). USG : ( 11/09/2010) Hepatomegaly Dilated billiary tree Cholelithiasis . ? Choledocholithiasis .

3. DILATED BILLIARY TREE AND DILATED PANCREATIC DUCT TIGHT STRICTURE IN THE DISTAL END OF THE CBD AND TIGHT NARROWING OF THE DISTAL END OF THE PANCREATCI DUCT FULL LENGTH DILATATION OF THE PANCREATIC DUCT WITH NO DILALTATION OF THE RAMIFICATIONS

4. DOUBLE DUCT SIGN STRONGLY SUGGESTIVE OF MALIGNANT ETIOLOGY

5. MASS LESION IN THE PERIAMPULLARY REGION WITH EVIDENT BULGE IN THE DUODENUM

6. CHOLELITHIASIS

7. MURAL THICKENING IN THE DISTAL PART OF THE CHOLEDOCHUS