Thickening of parallel folds in the wall of the small bowel resembling a stack of coins; indicates fluid in the bowel wall. Stack of coins sign refers to the appearance of small bowel folds that are smoothly and uniformly thickened . The margins between the folds are sharply delineated and the arrangement of clearly demarcated parallel folds is likened to a stack of coins or a picket fence.
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What is it? The stack of coins sign is a radiologic pattern seen on imaging of the gastrointestinal tract, where the bowel folds appear thickened and closely apposed, resembling stacked coins. It indicates submucosal edema or hemorrhage, leading to thickened and prominent valvulae conniventes.. The “stack of coins” sign typically indicates the presence of a small-bowel hematoma. This sign is seen on plain films or MDCT images and represents adjacent, thickened folds with sharp demarcation and crowding of the valvulae conniventes. [fig. 5]
