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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 16
| Issue : 2 | Page : 418-419 |
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Sonographic double-duct sign in obstructive jaundice
Rishabh Gupta, Suresh Phatak
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India
| Date of Submission | 17-Jul-2020 |
| Date of Decision | 21-Nov-2020 |
| Date of Acceptance | 31-Jan-2021 |
| Date of Web Publication | 18-Oct-2021 |
Correspondence Address:
Dr. Suresh Phatak
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMS-DU, Sawangi, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_271_20
How to cite this article:
Gupta R, Phatak S. Sonographic double-duct sign in obstructive jaundice. J Datta Meghe Inst Med Sci Univ 2021;16:418-9 |
Respected Sir,
We present ultrasonography (USG) findings of a case depicting double-duct sign, which is an important radiological sign in the case of obstructive jaundice observed in a case of carcinoma head of the pancreas.
A 65-year-old male patient presented with yellow sclera and vague abdominal pain. On examination, deep jaundice was present. On USG, gross intrahepatic biliary radicals and common bile duct (CBD) dilatation up to the lower end were seen [Figure 1] and [Figure 2]. Dilated main pancreatic duct was also seen [Figure 3]. An ill-defined mass was seen in the region of the head of the pancreas, suggestive of carcinoma [Figure 4]. | Figure 1: Gray-scale ultrasound showing evidence of obstructive jaundice in the form of dilated intrahepatic biliary radicals in the right and left lobes of the liver
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 | Figure 2: Dilated common bile duct, measuring 2.1 cm in diameter, as seen on gray-scale ultrasound
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 | Figure 3: Dilated main pancreatic duct measuring 6 mm as seen on gray-scale ultrasound
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 | Figure 4: Enlarged and bulky head of the pancreas showing a heterogeneous ill-defined mass in the head region
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The double-duct sign consists of simultaneous dilatation of the CBD and pancreatic duct. The most common cause of this sign has been found out to be choledocholithiasis followed closely by pancreaticobiliary malignancy.[1] The two most common malignant causes of the double-duct sign are carcinoma of the head of the pancreas and ampullary tumors (carcinoma of the ampulla of Vater). It is usually a result of narrowing of the terminal parts of both the ducts due to various causes, leading to encasement of the CBD and main pancreatic duct.[2] Because the causative tumors are often small, recognition of the sign can be critical to making a diagnosis. It may be observed on almost all imaging modalities including magnetic resonance imaging, computed tomography, ultrasound, and endoscopic retrograde cholangiopancreatography. Double-duct sign in magnetic resonance cholangiopancreatography (MRCP) is very important in the diagnosis of malignant obstructive jaundice.[3] MRCP of pancreatic carcinoma had displayed the double-duct sign in 86.5% of cases.[4]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Sinha R, Gardner T, Padala K, Greenaway JR, Joy D. Double-duct sign in the clinical context. Pancreas 2015;44:967-70.  |
| 2. | Sharma V, Rana SS, Chaudhary V, Dhaka N, Manrai M, Sivalingam J, et al. Opium-related sphincter of Oddi dysfunction causing double duct sign. Endosc Ultrasound 2016;5:269-71. [ PUBMED] [Full text] |
| 3. | Yang XQ, Yang AL, Yang M, Gao XC. Diagnostic value of double-duct-sign and four-segment-sign in MR cholangiopancreatography [J]. Chin J Med Imaging Technol 2007;6:967-70. |
| 4. | Meng Z, Xu YK, Zhang YP. Magnetic resonance cholangiopancreatography of pancreaticobiliary duct dilation due to pancreatic carcinoma and chronic pancreatitis. Nan Fang Yi Ke Da Xue Xue Bao 2008;28:113-5. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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