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©2013 UpToDate ® Print Email Abnormal ultrasound in a child with Clostridium difficile colitis Right lower quadrant intestinal ultrasound, 13-year-old girl with Down syndrome and acute lymphoblastic leukemia. This was her third episode of frequent voluminous watery diarrhea without blood or mucus following initiation of intravenous antimicrobial treatment for fever and neutropenia. C. difficile toxin A/B enzyme immunoassay was positive for both of the previous episodes. It was negative on the first two days of the present admission, then positive on day three when diarrhea worsened. Plain films showed marked paucity of intestinal gas; ultrasound showed up to 4 mm of bowel wall thickening in both right (above) and left lower quadrants. Courtesy of Dana Mazuru, MD, Department of Radiology, University of Missouri Health Care.