Can you make the diagnosis for this 65-year-old jaundice patient?

This patient is a 65-year-old with jaundice. You are initially shown one axial T2 spin-echo image (fig. 1, with fig. 1A provided for closer look at findings) with two green arrows pointing to what sign? To what sign is its single purple arrow pointing? Then you are shown an MR cholangiopancreatography (MRCP, w/ yellow arrow, fig. 2) and an axial T2-weighted image (w/ blue arrow, fig. 3). After seeing these two additional images, what is your diagnosis?

The green paired arrows in the first image point to the double duct sign (fig. 1A) of pancreatic carcinoma. The single purple arrow in the same image indicates a Courvoisier gallbladder from pancreatic obstruction. The MRCP (fig. 2) shows obstruction of the pancreatic and biliary ducts, both intra- and extrahepatic. The side branch clubbing of the pancreatic ducts indicated with the yellow arrow (fig. 2) is consistent with prior bouts of pancreatitis. The horizontal blue arrow (fig. 3) shows a swollen or enlarged pancreatic head and uncinate process. All of these factors combine to produce a diagnosis of pancreatic carcinoma. For more case review, check out MRI Online.

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