"Double duct" sign in a patient with pancreatic cancer

Endoscopic retrograde cholangiopancreatography (ERCP) in a patient with adenocarcinoma in the head of the pancreas. The common bile duct is dilated proximal to a stricture (arrow). In addition, the pancreatic duct is dilated (arrowhead) due to obstruction by the tumor. The dilation of both the common bile duct and the pancreatic duct is known as the "double duct" sign, a finding that is highly suggestive of a malignancy.