Carcinoma of the head of the pancreas.A double-contrast barium meal in a patient with progressive weight loss, abdominal pain and obstructive jaundice shows a very extensive lobulated filling defect, causing gross deformity of the concave aspect of the second and third parts of the duodenum. Contrast entered the dilated bile duct via a spontaneous fistula (arrow). The duodenal deformity corresponds with Frostberg's ‘reversed 3' sign  and is consistent with advanced pancreatic malignancy, although the appearance is not specific and is more frequently seen in pancreatitis.
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