BOWEL WALL THICKENING

How to differentiate bowel wall thickening due to different causes ?

Bowel wall thickening may be classified as follows with possible etiologies

Focal	<5 cm	Irregular and asymmetrical thickening	Malignancy (Exceptions: Crohn’s / Tuberculosis)
Focal	<5 cm	Regular, symmetric and homogeneous wall thickening- No fat stranding	Small and well differentiated adenocarcinoma/ lymphoma
Focal	<5 cm	Regular, symmetric and homogeneous wall thickening- With fat stranding	Diverticulitis, Epiploic Appendagitis, Omental Infarction and Appendicitis
Segmental	6-40 cm		Ischaemic, inflammatory or infectious conditions (Exception: Lymphoma)
Diffuse	>40 cm		Ischaemic, inflammatory or infectious conditions (Exception: Lymphoma)

References:

Fernandes, T., Oliveira, M.I., Castro, R. et al. Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 5, 195–208 (2014). https://doi.org/10.1007/s13244-013-0308-y