Stack of coins sign refers to the appearance of small bowel folds that are smoothly and uniformly thickened 1. The margins between the folds are sharply delineated, and the arrangement of clearly demarcated parallel folds is likened to a stack of coins or a picket fence.
Pathology
The smooth regular fold thickening is caused by intramural bleeding. Bleeding into the mesentery may cause loop displacement and separation.
Causes of bleeding leading to this pattern include:
anticoagulant therapy
coagulopathies secondary to other hematological disorders
Differential diagnosis
This stack of coins sign is distinct from the hidebound-bowel sign, in which the bowel folds are not thickened, which is a feature of systemic sclerosis and sprue.
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