Presentation
Jaundice and weight loss (painless).
Patient Data
There is a 3.2 x 3.4 x 2.6 cm (trans x CC x AP) mass in the pancreatic head. This results in marked intra and extrahepatic biliary dilatation with the common bile duct measuring up to 18 mm and distension of the gallbladder. There is marked dilatation of the pancreatic duct which measures up to 6 mm. Surrounding peripancreatic fat stranding with some nodularity suggesting infiltration. The mass contacts the portal vein and superior mesenteric vein without encasing them. The portal and splenic veins are patent. No lymphadenopathy identified.
No focal liver lesion. Large simple cyst arising from the left kidney. The right kidney, adrenals and spleen are unremarkable. Sigmoid diverticula disease. The large and small bowel are otherwise unremarkable. Small hiatus hernia. No free fluid or free gas.
Case Discussion
When the pancreatic and common bile ducts are dilated this is known as the double duct sign. Pancreatic adenocarcinoma is the most common cause. This can also be seen on ultrasound and MRI.
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