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 intramural hemorrhage/hematoma (trauma, anticoagulation, vasculitis, Henoch-Schönlein purpura), lymphoma or other infiltrative disease, and edema from ischemia or 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:
Picket-fence sign (used interchangeably for the same fold-thickening pattern)
Other associated named signs:
Hide-bound bowel sign is a related but distinct pattern: closely packed, normal-caliber (not thickened) valvulae conniventes in dilated small bowel loops, seen in scleroderma – unlike stack-of-coins, where the folds themselves are thickened.
References
Access all radiology signs posted so far: https://radiogyan.com/radiology-signs/
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