Figure 1: Click on image to enlarge.
Figure 2: Click on image to enlarge.
IMAGE OF THE WEEK
WEEK 41
THE DOUBLE DUCT Sign: AMPULLARY CARCINOMA
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Figure 1: Click on image to enlarge. |
Figure 2: Click on image to enlarge. |
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Abnormalities in the pancreatic head and the Ampulla of Vater can cause obstruction of both the pancreatic and common bile ducts. This will result in both the common bile duct and pancreatic duct becoming dilated leading to the appearance of the DOUBLE DUCT sign.
In some cases the cause of the DOUBLE DUCT sign will be visible, but not infrequently the cause cannot be confidently identified on ultrasound, CT or MRI, requiring direct visualisation with ERCP. The commonest causes are either a small pancreatic head tumour or a tumour at the ampulla of Vater (periampullary).
In this case the ‘double duct’ sign was beautifully illustrated on CT (Figures 1,2,3 and 4) with soft tissue at the ampulla due to an ampullary carcinoma (malignant epithelial tumour).
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Figure 3: Click on image to enlarge. |
Figure 4: Click on image to enlarge. |
The patient usually presents with jaundice, that may be accompanied with weight loss and or back pain. It is a rare tumour (0.2% of all GI tract tumours).
If there is no metastatic disease pancreatoduodenal resection (a Whipple’s procedure) is the treatment of choice.
Images contributed and prepared by
Dr Ian Bickle, Consultant Radiologist, Department of Radiology, RIPAS Hospital, Brunei Darussalam.
All images are copyrighted and property of RIPAS Hospital.
