Sonographic Murphy sign: Negative
Dilated main pancreatic and common bile ducts (“double duct sign”) with an ill-defined hypoechoic mass in the pancreatic head measuring 2.9 x 2.7 x 2.4 cm, concerning for pancreatic malignancy. Recommend surgical consultation and contrast-enhanced CT for further assessment.
Echogenic material layering in the distal common bile duct, which may represent sludge; however, recommend correlation with clinical signs of ascending cholangitis.
Borderline gallbladder wall thickening and mild gallbladder distension with layering gallstones and sludge, which are favored secondary to distal biliary obstruction rather than acute cholecystitis.