Echogenic bowel refers to the scan finding of brighter than usual bowel. The terms
‘hyperechoeic bowel’ and even ‘hyperechogenic bowel’ are sometimes used to mean the
Normally bowel appears grey. This is the case with most soft tissue. Bone appears
brighter, almost white. When the appearances of some sections of the bowel appear
as bright or even brighter than bone, this will be described as ‘echogenic’.
In the second trimester, echogenic bowel is seen in up to 1.4% of all babies or 1
in 70. Typically, the areas affected will appear with the same (or more) brightness
as the iliac bone in the baby’s pelvis.
Many conditions have been associated with the finding of echogenic bowel in the second
trimester. These include chromosomal anomalies (aneuploidy) such as Down’s; cystic
fibrosis, thalassaemia, intrauterine growth restriction (IUGR), viral and other infections
including parvovirus, CMV and toxoplasmosis. Crucially however, most babies found
to have echogenic bowel in isolation will be normal with none of the above conditions.
In any case, presence of echogenic bowel on a second trimester scan should trigger
a detailed scan to carefully look for other markers at the very least. If the woman
has another risk factor for Down’s syndrome (advanced age or family history), a diagnostic
test such as amniocentesis should be offered.
It is important to be aware that echogenic bowel in the final weeks of pregnancy
in the third trimester is much more common and does not carry anywhere near the same
degree of significance.