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Thickened Submucosal Layer

A Sonographic Sign of Acute Gastrointestinal Abnormality Representing Submucosal Edema or Hemorrhage

¹ Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Rm. H1307, Stanford, CA 94305.
² Department of Radiology, Mail stop 114, Veterans Administration Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304.

OBJECTIVE. We correlated the sonographic appearance of bowel wall thickening with the acuity of the underlying disease process.

SUBJECTS AND METHODS. Sonograms of thickened bowel walls were reviewed in 37 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laboratory data, barium studies, and CT.

RESULTS. Twenty-eight patients presented acutely, and nine patients had chronic or subacute disease processes. Two of the 28 patients had concurrent acute and chronic processes. In 27 of 28 patients with acute processes, the abnormal bowel segments were characterized by an echogenic submucosal layer thicker than 2.5 mm. In contrast, nine patients with chronic or subacute processes had relatively uniform hypoechoic thickening of the bowel wall with loss of visualization of a discrete echogenic submucosal layer. CT was available for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corresponded to either low-attenuation submucosal edema (n = 25) or acute submucosal hemorrhage (n = 3).

CONCLUSION. The finding of a thickened submucosal layer suggests an acute disease process of the bowel and corresponds to either submucosal edema or hemorrhage.

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