Echogenic Bowel
Roya Sohaey, MD
DIFFERENTIAL DIAGNOSIS
Common
Idiopathic
Trisomy 21
Cystic Fibrosis
Infection
Cytomegalovirus
Parvovirus
Toxoplasmosis
Meconium Peritonitis, Pseudocyst
Less Common
Ingested Blood
Intrauterine Growth Restriction (IUGR)
Rare but Important
Bowel Ischemia
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Echogenic bowel (EB) grading
Grade 0: < Liver (normal)
Grade 1: > Liver, < bone (normal)
Grade 2: = Bone (potentially abnormal)
Grade 3: > Bone (potentially abnormal)
Focal EB more likely pathologic than diffuse EB
High frequency probe may cause false EB
Helpful Clues for Common Diagnoses
Idiopathic
0.6% incidence (unknown etiology)
Trisomy 21
6.7x ↑ maternal a priori risk when isolated
Look for other markers
Cystic Fibrosis
↑ In northern European Caucasians
± Bowel obstruction (meconium ileus)
Infection
Cytomegalovirus most common
Microcephaly (± calcifications)
Intrauterine growth restriction
Hydrops
Meconium Peritonitis, Pseudocyst
Bowel perforation
peritonitis
Linear and punctate echoes/calcifications
Outline liver and bowel
Pseudocyst = walled-off fluid
Dilated bowel from associated atresia
Helpful Clues for Less Common Diagnoses
Ingested Blood
Dependent layering in stomach
Often transient
Look for evidence of prior perigestational hemorrhage as source for blood
Intrauterine Growth Restriction (IUGR)
18% of 2nd trimester fetuses with EB develop IUGR
EB + ↑ Alpha fetoprotein = severe placental insufficiency
Helpful Clues for Rare Diagnoses
Bowel Ischemia
From any fetal hypotensive event
Associated with twin-twin transfusion
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