The identification of echogenic or dilated bowel on fetal ultrasonography may be an early indication of cystic fibrosis (CF) or trisomy.
Slotnick and Abuhamad developed a classification for bowel echogenicity based on how the bowel image changed with gain reduction as compared to bone in the iliac crest.
Disappearance After Gain Reduction
Ultrasonographic Findings
Grade
no increase in sonodensity
normal fetal bowel
0
sonodense, with image lost before bone in the iliac crest
slight hyperechogenicity
1
sonodense, similar to bone in the iliac crest
moderate hyperechogenicity
2
sonodense with image lost after bone in iliac crest
marked hyperechogenicity
3
Grade
Risk of CF or Trisomy
0
very low
1
very low
2
low
3
low to moderate (5 to 45%)
The dilation of small bowel loops may indicate bowel obstruction due to a meconium plug or other cause.
The workup of hyperechogenic and/or dilated small bowel loops may include:
(1) a careful ultrasonographic examination for other abnormalities
(2) consider performing cytogenetics and testing for cystic fibrosis on the fetus
(3) consider testing the parents for cystic fibrosis
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