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Does the double duct sign always consistent with tumoural causes ?
Although carcinoma of the head of the pancreas and ampullary tumours are the most common causes of the double duct sign it can occasionally occur with an impacted gall stone in the distal duct, with associated edema that compress and blocks the pancreatic duct.
Simultaneous dilatation of the common bile and pancreatic ducts due to mass of the head of the pancreas.