What causes stack-of-coins appearance in small bowel on imaging?
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Answer:
Closely spaced circular bowel wall thickening due to prominent valvulae conniventes traversing the entire width of jejunal loops, seen in small bowel lymphoma, intramural hematoma, or edema from obstruction.
Why is it called so?:
The sign resembles a stack of coins due to the appearance of multiple, closely spaced, uniform circular rings formed by thickened valvulae conniventes aligned across bowel loops on cross-sectional imaging.
Pathophysiology:
Diffuse circumferential infiltration or submucosal edema/hemorrhage causes symmetric thickening of valvulae conniventes, leading to preservation of their full transverse diameter and producing evenly spaced, coin-like opacities on plain films or CT when viewed en face.
Alternative names: None
Other associated named signs: String of pearls sign
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