Small bowel fold thickening (differential)

Last revised by Daniel J Bell on 21 Jun 2021

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Bell D, Thurston M, et al. Small bowel fold thickening (differential). Reference article, Radiopaedia.org (Accessed on 23 Apr 2024) https://doi.org/10.53347/rID-2058

DOI:

https://doi.org/10.53347/rID-2058

Permalink:

https://radiopaedia.org/articles/2058

rID:

2058

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

21 Jun 2021, Daniel J Bell ◉

Disclosures:

At the time the article was last revised Daniel J Bell had no recorded disclosures.

View Daniel J Bell's current disclosures

Revisions:

8 times, by 5 contributors - see full revision history and disclosures

Systems:

Gastrointestinal

Sections:

Gamuts

Tags:

emergency medicine, fluoroscopy, ct enterography

Synonyms:

Small bowel folds DDx
SB folds thickening differential

The differential diagnosis of small bowel fold thickening is broad. Diffuse fold thickening may be "regular and smooth" or "irregular and nodular".

edema
- congestive cardiac failure (CCF)
- hypoalbuminemia
- lymphatic obstruction
- angioneurotic edema
- infection
- radiation
- ischemia
hemorrhage
- anticoagulation or bleeding diathesis
- vasculitides
  - IgA vasculitis (Henoch-Schonlein purpura)
  - Buerger disease
  - graft-versus-host disease (GVHD)
- hemolytic uremic syndrome (HUS)
- disseminated intravascular coagulation (DIC)
- trauma
cellular/proteinaceous infiltrates
- lymphoma/leukemia
- eosinophilic enteritis: early, before becoming irregular
- amyloidosis: early, before becoming irregular

This is a long list and dividing patients by age and presentation helps somewhat.

Elderly, acute presentation: Top 3

ischemia (arterial or venous)
hemorrhage (warfarin)
?

Elderly, chronic/asymptomatic presentation: Top 3

edema from CCF, hypoalbuminemia
lymphatic obstruction
lymphoma/leukemia

Young, acute presentation: Top 3

infective
inflammatory: e.g. Crohn disease
vasculitis

Young, chronic/asymptomatic presentation: Top 3

lymphoma/Leukemia
radiation
inflammatory: e.g. Crohn disease

Irregular, nodular generalized thickening

neoplasms
- metastases, especially melanoma
- lymphoma
infection
- Giardiasis
- Whipple disease
- tuberculosis: typically terminal ileum
- Yersinia: typically terminal ileum
- Strongyloidiasis: more pronounced proximally
inflammatory/cellular/proteinaceous infiltrate