Thickened submucosal layer: A sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage

OBJECTIVE. We correlated the sonographic appearance of bowel wall thickenin g with the acuity of the underlying disease process. SUBJECTS AND METHODS. Sonograms of thickened bowel walls were reviewed in 3 7 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laborato ry data, barium studies, and CT. RESULTS. Twenty-eight patients presented acutely, and nine patients had chr onic or subacute disease processes. Two of the 28 patients had concurrent a cute 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 p rocesses had relatively uniform hypoechoic thickening of the bowel wall wit h loss of visualization of a discrete echogenic submucosal layer. CT was av ailable for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corre sponded to either low-attenuation submucosal edema (n = 25) or acute submuc osal hemorrhage (n = 3). CONCLUSION. The finding of a thickened submucosal layer suggests an acute d isease process of the bowel and corresponds to either submucosal edema or h emorrhage.