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Echogenic Bowel

Overview

Echogenic bowel commonly is a normal variant but may be present in association with a number of anomalies including:

  1. small bowel atresia or volvulus
  2. fetal viral infection, typically CMV
  3. chromosomal abnormalities, typically trisomy 21, but 18 also has been reported
  4. growth retardation
  5. cystic fibrosis

For this finding to be described as abnormal by ultrasound the echogenicity must be equal to or greater than that of the adjacent bone. Technical factors are important in scanning since high frequency transducers will make normal bowel appear echogenic. If there is a question of echogenic bowel, the fetus should be scanned with a 3 MHz transducer (or a 2-MHz transducer, if that's all that's available). This is a second trimester finding. Meconium in the colon in the third trimester frequently will appear echogenic, and has no significance to the fetus.

Recommendations

  1. Due to the association with cystic fibrosis and chromosomal anomalies, we recommend genetic counseling, amniocentesis, and cystic fibrosis carrier screening of both parents.
  2. ****Note, when doing an amniocentesis in a fetus with echogenic bowel, an additional 3 cc of amniotic fluid needs to be sent to microbiology for CMV testing. You must specifically write on the cytology request to include amniotic fluid titers and PCR analysis. The cytogenetics laboratory should be notified to save a back-up of cells for possible cystic fibrosis screening.
  3. Regardless of whether an amniocentesis is performed, due to the association with IUGR, we recommend a follow-up scan at 28 weeks.

References

  • Bromley B, Doubilet P, Frigoletto FD, Krauss C, Estroff JA, Benacerraf BR. Is fetal hyperechoic bowel on second-trimester sonogram an indication for amniocentesis? Obstet Gynecol 1994: 83:647-51
  • Dicke JM, Crane JP: Sonographically detected hyperechoic fetal bowel: significance and implication for pregnancy management. Obstet Gynecol 80:778, 1992
  • Goldstein RB, Ultrasound evaluation of the fetal abdomen, in Callen PW, editor Ultrasonography in obstetric s and gynecology. W. B. Saunders publishers, 1994.
  • Paulson EK, Hertzberg BS: Hyperechoic meconium in the third trimester fetus: an uncommon normal variant. J Ultrasound Med 10:677, 1991
  • Scioscia AL, Pretorius DH, Budorick NE, et al: Second-trimester echogenic bowel and chromosomal abnormalities. AM J Obstet Gynecol 167:889, 1992