Bowel wall thickening
Updates to Article Attributes
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was changed:
Bowel wall thickening is a useful finding on imaging studies and has a number of different causes.
Pathology
The reason for bowel wall thickening depends on the underlying etiology, but includes submucosal edema, hemorrhage, and neoplastic infiltration.
Radiographic features
In describing bowel wall thickening, certain descriptors can be useful in generating a differential diagnosis 1
- how thick is the bowel wall?
- mild, moderate, severe
- what is the attenuation / enhancement pattern of the bowel wall?
- how much of the bowel is affected?
- short segment? multiple loops? small bowel and colon?
- is the bowel wall thickened symmetrically or asymmetrically?
Plain radiography
- bowel wall thickening can be seen through thickening of the
plica semilunaresvalvulae conniventes (small bowel) or haustral folds (colon) - the true thickness of the bowel wall should not be visible
- if both sides of the bowel wall are visible, it likely indicates pneumoperitoneum
Fluoroscopy
- detection of bowel wall thickening on fluoroscopy is similar in principle to radiography and relies on evaluating the thickness of bowel wall folds
CT / CT enterography
- some sources suggest >2-3 mm as a numerical cut off for small bowel wall thickening 2
-
CT enterography is more useful for evaluation of bowel thickening because of
- better luminal distention
- earlier contrast timing that accentuates bowel wall mucosal enhancement
MRI / MR enterography
- findings in MRI and MR enterography are mostly analogous to CT, but submucosal edema can be more directly evaluated with T2-weighted imaging
Differential diagnosis
- collapsed bowel
If due to an inflammatory condition, the thickening represents submucosal edema. This type of thickening can be seen in
- inflammatory bowel disease, such as Crohn disease or ulcerative colitis
- diverticulitis
- infection, such as Clostridium difficile
colitis/ pseudomembranous colitis - bowel ischemia
- radiation enteritis
Bowel wall thickening may also be due to neoplastic infiltration of the wall, such as with
Bowel wall may be thickened in other conditions as well
- angioedema
- bowel trauma / submucosal hemorrhage
- Henoch-Schonlein purpura
- edema from hypoproteinemia
Practical points
- it can sometimes be difficult to differentiate between collapsed bowel and pathologic bowel wall thickening -- look for secondary signs such as mesenteric edema, vascular engorgement, lymphadenopathy, or differential bowel wall enhancement to help confirm that the bowel wall thickening is pathologic
- if trying to decide if bowel wall is thickened or just collapsed, compare the wall with other loops of bowel in nearby and distant segments
-<li>what is the <a title="Abnormal bowel wall attenuation patterns" href="/articles/abnormal-bowel-wall-attenuation-patterns">attenuation / enhancement pattern of the bowel wall</a>?</li>- +<li>what is the <a href="/articles/abnormal-bowel-wall-attenuation-patterns">attenuation / enhancement pattern of the bowel wall</a>?</li>
-<li>bowel wall thickening can be seen through thickening of the plica semilunares (small bowel) or haustral folds (colon)</li>-<li>the true thickness of the bowel wall should not be visible<ul><li>if both sides of the bowel wall are visible, it likely indicates <a title="Pneumoperitoneum" href="/articles/pneumoperitoneum">pneumoperitoneum</a>- +<li>bowel wall thickening can be seen through thickening of the <a title="Valvulae conniventes" href="/articles/valvulae-conniventes">valvulae conniventes</a> (small bowel) or <a title="Haustral folds" href="/articles/haustral-folds">haustral folds</a> (colon)</li>
- +<li>the true thickness of the bowel wall should not be visible<ul><li>if both sides of the bowel wall are visible, it likely indicates <a href="/articles/pneumoperitoneum">pneumoperitoneum</a>
-<a title="CT enterography" href="/articles/ct-enterography">CT enterography</a> is more useful for evaluation of bowel thickening because of<ul>- +<a href="/articles/ct-enterography">CT enterography</a> is more useful for evaluation of bowel thickening because of<ul>
-</ul><h5>MRI / MR enterography</h5><ul><li>findings in MRI and <a title="MR enterography" href="/articles/mr-enterography">MR enterography</a> are mostly analogous to CT, but submucosal edema can be more directly evaluated with T2-weighted imaging</li></ul><h4>Differential diagnosis</h4><ul><li>collapsed bowel</li></ul><p>If due to an inflammatory condition, the thickening represents submucosal edema. This type of thickening can be seen in </p><ul>- +</ul><h5>MRI / MR enterography</h5><ul><li>findings in MRI and <a href="/articles/mr-enterography">MR enterography</a> are mostly analogous to CT, but submucosal edema can be more directly evaluated with T2-weighted imaging</li></ul><h4>Differential diagnosis</h4><ul><li>collapsed bowel</li></ul><p>If due to an inflammatory condition, the thickening represents submucosal edema. This type of thickening can be seen in </p><ul>
-<a href="/articles/inflammatory-bowel-disease">inflammatory bowel disease</a>, such as <a href="/articles/crohn-disease-1">Crohn disease</a>- +<a href="/articles/inflammatory-bowel-disease">inflammatory bowel disease</a>, such as <a href="/articles/crohn-disease-1">Crohn disease</a> or <a title="Ulcerative colitis" href="/articles/ulcerative-colitis">ulcerative colitis</a>
-<li>infection, such as <a href="/articles/clostridium-difficile-colitis"><em>Clostridium difficile</em> colitis</a>- +<li>infection, such as <a href="/articles/clostridium-difficile-colitis"><em>Clostridium difficile</em> / pseudomembranous colitis</a>
-<li>-<a href="/articles/small-bowel-lymphoma-1">carcinoma, such as </a><a href="/articles/colorectal-carcinoma">colonic adenocarcinoma</a>- +<li>malignancy, such as <a title="Colon cancer" href="/articles/colorectal-carcinoma">colonic adenocarcinoma</a>
-<li>it can sometimes be difficult to differentiate between collapsed bowel and pathologic bowel wall thickening -- look for secondary signs such as mesenteric edema, vascular engorgement, lymphadenopathy, or <a title="Abnormal bowel wall attenuation patterns" href="/articles/abnormal-bowel-wall-attenuation-patterns">differential bowel wall enhancement</a> to help confirm that the bowel wall thickening is pathologic</li>-<li>if trying to decide if bowel wall is thickened or just collapsed compare the wall with other loops of bowel in nearby and distant segments</li>- +<li>it can sometimes be difficult to differentiate between collapsed bowel and pathologic bowel wall thickening -- look for secondary signs such as mesenteric edema, vascular engorgement, lymphadenopathy, or <a href="/articles/abnormal-bowel-wall-attenuation-patterns">differential bowel wall enhancement</a> to help confirm that the bowel wall thickening is pathologic</li>
- +<li>if trying to decide if bowel wall is thickened or just collapsed, compare the wall with other loops of bowel in nearby and distant segments</li>
References changed:
- 1. Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR. American journal of roentgenology. 176 (5): 1105-16. <a href="https://doi.org/10.2214/ajr.176.5.1761105">doi:10.2214/ajr.176.5.1761105</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11312162">Pubmed</a> <span class="ref_v4"></span>
- 2. James S, Balfe DM, Lee JK, Picus D. Small-bowel disease: categorization by CT examination. AJR. American journal of roentgenology. 148 (5): 863-8. <a href="https://doi.org/10.2214/ajr.148.5.863">doi:10.2214/ajr.148.5.863</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3495119">Pubmed</a> <span class="ref_v4"></span>
- 3. Chou CK, Chen LT, Sheu RS, Wang ML, Jaw TS, Liu GC. MRI manifestations of gastrointestinal wall thickening. Abdominal imaging. 19 (5): 389-94. <a href="https://www.ncbi.nlm.nih.gov/pubmed/7950809">Pubmed</a> <span class="ref_v4"></span>
Systems changed:
- Gastrointestinal
Sections changed:
- Gamuts
Images Changes:
Image 1 CT (C+ portal venous phase) ( create )
Image 2 CT (C+ portal venous phase) ( create )
Image 3 CT (C+ portal venous phase) ( create )
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