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(the "double duct" sign), a pancreatic duct stricture in excess of 1 cm in length, pancreatic duct obstruction, and the absence of changes suggestive of chronic . Double-duct sign, on MRCP and/or CT of the pancreatobiliary system, refers to co-existing dilatation of the CBD and PD. Follow-up information was available for a median of 27 months (range, 12-42 months) Results The commonest cause of double-duct . PDF Pancreatic Cancer: The Presentation Surgical Oncologist's ... The double-duct sign presents as dilation of the pancreatic duct and common bile duct on imaging studies. PDF CaRport Somatostatinoma Presented as Double-Duct Sign Figure 2. 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 . A pancreatic pseudocyst causing obstructive jaundice with a double-duct sign, as described in our case, is very rare. PMID: 1265253 ERCP is a procedure that allows your doctor to see the small tubes inside your body called the pancreatic and bile ducts. Magnetic Resonance Cholangiopancreatography - Radiology Key It takes between 30 minutes and an hour. The results suggest that ERCP is an accurate and reliable method for diagnosing pancreatic carcinoma. "Blind" evaluation of endoscopic retrograde ... A 57 year old female presents with jaundice. 3a: Pancreatic Cancer. Twelve percent of isolated PDS and 79% of CBD stricture-associated PDS were malignant. ERCP is used in diagnosing and treating the following conditions: Blockage of the bile duct by gallstones, cancer, strictures (scarring) or compression from adjacent organs or tumors. Double duct sign: reassessed significance in ERCP Biopsies were taken and histopathology was unrevealing. Tissue diagnosis The double duct sign appeared in four of eight pancreatic carcinoma patients, but also occurred in 15 of 41 pancreatitis patients. ERCP showing a distal bile duct stricture raising concern for It can help to diagnose conditions of the liver, bile ducts, pancreas or gallbladder. AST U/L, ALT of U/L, total protein. 27 cases (90.0%) showed double duct sign and no significant dil-atation of gallbladder. 1 In various studies sensitivity and specificity of ERCP for pancreatic cancer reached 78% to 95%. The characterization of a malignant biliary obstruction by ERCP followed the known criteria: irregularly shaped intraluminal filling defect of the bile duct, promptly and irregularly altered shape of a distal narrow segment, and (B) A 3D MRCP image shows a DBS with abrupt, eccentric and asymmetric narrowing, obtuse angle of the narrowing end, irregular margins, and the presence of the double duct sign (white arrow). The double duct sign. The double duct sign (DDS) consists of simultaneous dilatation of the CBD and PD, usually owing to malignancy involving lower part of CBD and PD. Occasionally, benign causes like chronic pancreatitis or sphincter of Oddi dysfunction (SOD) may cause double duct sign. The double duct sign. This patient had pancreatic carcinoma. Gastrointest Endosc. This sign is frequently encountered in radiological imaging. Percutaneous transhepatic drainage . Cholangitis is the infection of the common bile duct, which transmits the body's bile to the intestines and gallbladder from where bile is created in the liver. 104-107 The double duct represents simultaneous dilatation of the . ERCP • "double duct sign" suggestive of an obstructive mass • sampling of ductal strictures • placement of biliary stent. 1 From the Department of Computed Tomography, Centro Radiológico Luis Méndez Collado, Muñecas 444, San Miguel de Tucumán, Tucumán 4000, Argentina. We wish to investigate the prognostic value of the "double-duct" sign in patients who undergo Magnetic resonance cholangio-pancreatography (MRCP), attempting to define the . Benign causes include chronic pancreatitis and sphincter of Oddi dysfunction (SOD). In 90% of cases, this indicates the presence of adenocarci-noma of the pancreas. Article PubMed Google Scholar 2. The double duct sign, a simultaneous stenosis of the common bile duct and the pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP), has been reported to predict the presence of . We retrospectively analyzed MRCP database over a period of 4 years, January 2010 to December 2013. These tubes are near your stomach. This video shows the insertion of a metallic biliary stent in a patient with inoperable pancreatic cancer. Whereas the double duct sign is often seen in association with pancreatic head carcinoma, it is a nonspecific sign that may be due to a benign or malignant process involving the pancreatic head. The double duct sign refers to the presence of simultaneous dilatation of the common bile and pancreatic ducts. 103 To date, this sign has also been described using magnetic resonance cholangiopancreatography (MRCP), multidetector CT (MDCT), and ultrasound (US). Her ERCP shows dilatation of the bile duct and pancreatic duct - the "double duct" sign characteristic of adenocarcinoma of the head of the pancreas. The cystic duct was also outlined (A: green arrow). . Endoscopic ultrasound (EUS): Duplication of the extrahepatic bile is an extremely rare congenital anomaly of the biliary system, which is characterized by the presence of a septum within the common bile duct or an accessory common bile duct. e double-duct sign usually indi2, - cates pancreatic malignancy with a lower prevalence in Further workup revealed negative viral A double-duct sign is the combined dilatation of the common bile duct and pancreatic duct, often caused by cancer of the pancreas. Findings suggestive of a tumor/mass include super-impassable strictures, obstruction of the common bile and pancreatic ducts (the "double duct" sign), a pancreatic duct stricture in excess of 1 cm in length, pancreatic duct obstruction, and the absence of changes suggestive of chronic pancreatitis. The right and left ductal systems were dilated and a stricture was seen just below the confluence (B: white arrow. Double duct sign where there is a simultaneous dilatation of both the common bile duct (CBD) and pancreatic duct is usually associated with sinister causes like malignancies of pancreatic head or ampulla. We performed an ERCP, which revealed 2 cm ampullary lesion with upstream obstruction. . 1 Introduction. The Double Duct Sign. Tissue diagnosis ERCP • study of ERCP-sampling of strictures suspicious for cancer cytology brush De Billis, et al. It is observed on imaging during endoscopic retrograde cholangio-pancreatography, magnetic resonance cholangio . Double duct sign; ERCP is needed for more evaluation. Results: 218 (61%) patients with a PDS were found to have an isolated PDS. The "double duct" sign was initially described through the use of endoscopic retrograde cholangiopancreatography (ERCP). Analysis of Bile Duct Dilation We observed intrahepatic and extrahepatic bile duct, and pancreatic duct dilation in pan-creatic head cancer cases. IgG4-related disease had been well documented to involve many organs, such as lymph nodes, pancreas, salivary gland, thyroid gland, biliary tract, retroperitoneum, kidney, gallbladder, mesentery, lung and prostate. A 68-year-old Afro-Caribbean woman was referred to our hospital in January, 2002, for endoscopic retrograde cholangio-pancreatography (ERCP). In this case the stricture appears quite distal. Double-duct sign, on MRCP and/or CT of the pancreatobiliary system, refers to co-existing dilatation of the CBD and PD. The first double common bile-duct (DBCD) case was reported by Vesalius in 1543. Magnetic resonance cholangiopancreatography (MRCP) is a technique that has evolved over the past two decades. You have this test as an outpatient. 3. Freeny PC, Bilbao MK, Katon RM (1976) "Blind" evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: the "double duct" and other signs. The "double-duct sign" refers to the simultaneous dilatation of the common bile duct (CBD) as well as the pancreatic duct (PD) and was originally described during endoscopic retrograde cholangiopancreatography (ERCP) [1, 2].It has long been considered an ominous finding, potentially suggestive of malignancy of the pancreatic head or ampulla of Vater []. It continues to have a fundamental role in the non-invasive investigation of many pancreatico-biliary disorders. ERCP stands for endoscopic retrograde cholangio pancreatography. The double duct sign refers to the presence of simultaneous dilatation of the common bile and pancreatic ducts. Methods We aim to correlate double-duct sign discovered on magnetic resonance cholangiopancreatogram (MRCP) in the clinical context. 1: Pheochromocytoma 2: Cleidocranial dysostosis 3: Bilirubin Stone in Hereditary Spherocytosis, Papillary Stenosis after Endoscopic Stone Removal (ERCP) 4: Brain Abscess with Frontal Sinus Defect 5: Neurofibromatosis Type I Patients with obstructive jaundice in the context of a double-duct sign have a high incidence of malignancy [7-9]. A blind study of 49 patients with narrowing of the common bile duct or pancreatic duct on endoscopic retrograde cholangiopancreatography (ERCP) was done. The purpose of this review is to summarise the key concepts behind MRCP, the different techniques that are currently employed (including functional and secretin-stimulated . Double duct sign is an anatomical sign of combined dilatation of common bile duct and pancreatic duct. A pancreatic pseudocyst causing obstructive jaundice with a double-duct sign, as described in our case, is very . Introduction "Double-duct" sign on ERCP (Endoscopic retrograde cholangio-pancreatogram) is considered suggestive of pancreatic or biliary malignancy. Double duct sign; ERCP is needed for more evaluation. Mass - Forming Chronic Pancreatitis: CT and ERCP Features Dong Jin Jung, Hyun Kwon Ha, Yong Suk Lee, Jin Hwa Lee, Pyo Nyun Kim, Moon Gyu Lee and Yong Ho Auh Department of Diagnostic Radiology, Asan Medical Center, College of Medicine University of Ulsan, Korea. 2 It has been further suggested that the presence of a double duct sign on ERCP, coexistent and adjacent stenoses of the main pancreatic duct and the common bile duct . The ERCP suggests a "double duct" sign. Two cases of double-duct sign were due to opiate-associated sphincter of Oddi dysfunction [3]. AJR:138, January 1982 DOUBLE DUCT SIGN IN ERCP 33 TABLE2:Character ofDuctalStenosis orObstruction in52 Patients withDuctalCharacter inDoubleDuctSignbyERCP Malignant Benign (n-30) (n=22) Character PancreaticCommonBile Duct Duct PancreaticCommonBile Duct Duct Abruptirregular 15 13 7 3 Abruptsmooth 5 9 3 0 Gradualsmooth. Initially, the double duct sign was thought to predict the presence of pancreatic carcinoma with a specificity approaching 100%. The pancreas is bulky but the CBD is not dilated at that point nor is the pancreatic duct dilated. The patient had emigrated from Grenada at age 24 . Bile duct obstruction or blockage may lead to cholangitis. 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 . Received November 21, 2004; revision requested January 1, 2005; revision received January 14; final version accepted February 16. Image 2 (ERCP): "Double-duct" sign - strictures are seen in the common bile duct (yellow arrow) and pancreatic duct (grey arrow) with dilatation of the pancreatic duct. The double duct sign is an anatomical sign of combined dilatation of common bile duct and pancreatic duct that is highly diagnostic of pancreatic carcinoma in jaundiced patient. The double duct sign, defined as an abnormality of both the pancreatic duct and the contiguous part of intrapancreatic common bile duct, was found in 52 of 1180 patients studied by endoscopic retrograde cholangiopancreatography. Severe intrahepatic and extrahe- Herein, we present a 43-year old male patient who was referred by his primary care physician to our gastroenterology clinic due to elevated liver function test and double-duct sign on CT scan. The guidewire was finally placed across the strictured part after a few attempts and contrast injection outlined the full biliary tree. ERCP showing a classic "double-duct sign": both the bile duct and the pancreatic duct are narrowed in the head of the pan-creas. Ahualli J (2007) The double duct sign. They carry digestive juices from your liver and pancreas to the intestines. This sign is considered menacing since the two most common causes are malignancies of either the pancreas or the ampulla of Vater [].However, benign causes have also been reported to cause a double-duct sign, including chronic pancreatitis and ampullary stenosis []. Sensitivity, specificity, and accuracy of MRCP and ERCP were calculated by using ratings of confidence in image-based diagnosis. g/dl. ERCP is one of the most sensitive and specific imaging techniques presently available for the diagnosis of pancreatic cancer. Infection after ERCP may also develop. On ERCP, contrast injection outlined a markedly dilated CBD and intrahepatic channels (B1 & B2: green arrows) with a sharp cutoff point near the level of cystic duct. This sign can also be seen with other modalities such as endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT, especially with curved . One is insertion of DBE and the other is an ERCP‐related . a formal abdominal ultrasound followed by an ERCP and stent placement and . We present a patient with colicky pain in the right upper quadrant of her abdomen. Benign causes include chronic pancreatitis and sphincter of Oddi dysfunction (SOD). The double duct sign (DDS) consists of simultaneous dilatation of the CBD and PD, usually owing to malignancy involving lower part of CBD and PD. APPEARANCE The double duct sign is a finding seen at magnetic resonance (MR) cholangiopancreatography (a two-dimensional technique) and consists of simultaneous dilatation of the common bile and pancreatic ducts ( Figure ) ( 1 , 2 ). Stricturing of CBD and pancreatic duct at ampulla. The CT study shows a double duct sign that refers simultaneous dilatation of the common bile and pancreatic ducts . Somatostatinoma Presented as Double-Duct Sign AliZakaria ,1 NourHammad,2 CynthiaVakhariya,3 andMichaelRaphael1 . Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. For ERCP, your doctor uses a flexible lighted tube called an "endoscope.". Figure 1 (A) A 3D MRCP image shows a DBS with gradual tapering, concentric and symmetric narrowing, acute angle of the narrowing end, smooth margins, and absence of the double duct sign (white arrow). The double duct sign, a simultaneous stenosis of the common bile duct and the pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP), has been reported to predict the presence of . 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