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• W2921057726 abstract "The “double duct sign” describes radiographic evidence of dilatation of both the common bile duct (CBD) and pancreatic duct. This sign tends to be an alarming finding, as it is highly associated with malignancy, particularly tumors of the pancreatic head. Similarly, CA 19-9 is a serologic marker used in diagnosing and monitoring malignant disease of the pancreas, gallbladder, and bile duct. While both the double duct sign and CA 19-9 are associated with malignancy, they are also less commonly associated with benign conditions. A 70 year-old-male with hypertension and coronary artery disease presented with 3 days of colicky right upper quadrant abdominal pain and confusion. He was found to be febrile, tachycardic, and tachypneic. His exam was notable for jaundice and a mildly distended, but soft abdomen with moderate tenderness in the right upper quadrant. His labs were significant for leukocytosis to 24.0 103 ml, aspartate aminotransferase 220 IU/L, alanine aminotransferase 346 IU/L, alkaline phosphatase 363 IU/L, total bilirubin 15.1 mg/dL, direct bilirubin 14.1 mg/dL, and lipase 119 U/L. His CT abdomen/pelvis revealed pancreatic inflammation, a dilated pancreatic duct (9 mm), CBD of 1.8 cm, and a 1.1 cm hyperdensity within the CBD. Findings were concerning for a pancreatic head mass. CA 19-9 was 17,788 U/mL. Endoscopic retrograde cholangiopancreatography (ERCP) was notable for a large stone obstructing the ampulla and biliary sphincterotomy and stone extraction was performed. He improved clinically and his CA 19-9 was 535 on the day of discharge. Eight weeks later, a repeat pancreatobiliary endoscopic ultrasound and ERCP showed a main pancreatic duct of 2.5 mm and CBD of 7 mm. There was no evidence of abnormality or mass in the pancreatic head, body, or tail. The double duct sign is highly associated with malignancy, with reported prevalence of malignancy in 58-100% of patients. CA 19-9 is a serologic marker used to aid in the diagnosis and monitoring of malignancy of the pancreas, gallbladder, and bile duct. Elevated levels of CA 19-9 have also been associated with benign conditions, notably acute cholangitis and choledocholithiasis, and there is one case report that describes a patient with double duct sign from choledocholithiasis. To our knowledge, this is the only report of a case of a patient with obstructive jaundice, elevated CA 19-9, and double duct sign that was not found to have an underlying pancreatobiliary malignancy." @default.
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• W2921057726 date "2018-10-01" @default.
• W2921057726 modified "2023-10-18" @default.
• W2921057726 title "Double Duct Sign and Elevated CA 19-9 - Clinical Correlation Is Always Needed" @default.
• W2921057726 doi "https://doi.org/10.14309/00000434-201810001-01274" @default.
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