By paying careful attention to technique, two identifiable patterns of small bowel pathology can be seen. These patterns, the pseudokidney sign and tubular sonolucent masses occur in both benign and malignant disease. For the pseudokidney sign to be present, lesions can occur either on a mucosal or serosal surface and extend toward the opposite surface to cause thickening of the bowel wall. Barium studies can be negative and yet a bowel lesion can indeed be present. The most important criteria for identification of these lesions is the continued presence of these masses with real-time. In the absence of real-time, repeat examinations at different times should prove these masses persistent. When these masses are identified, the examiner should carefully examine the patient to be certain that no other evidence of abnormality can be seen and to exclude the possibility of metastatic spread of disease. In those patients in which a pseudokidney is seen, the examiner should be certain that both kidneys are in normal position and that the mass is not an ectopic kidney. With the more frequent use of ultrasound as a screening tool, the identification of bowel lesions with sonography can help the clinician rapidly determine the correct diagnosis and thus save the patient considerable time and money by avoiding unnecessary diagnostic tests.