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A 6-year-old male with acute appendicitis and fever. A: Distended appendix with dirty intraluminal fluid and hyperemia of appendiceal wall on color Doppler study (arrows). Periappendiceal mesenteric fat infiltration was identified; B: Because of lobar pneumonia, surgery was delayed and antibiotic therapy given. On follow-up ultrasonography 3 d later, the maximal outer diameter of appendix (arrows) was decreased to 4 mm with disappearance of intraluminal content; C: On follow-up after 6 d, the wall layers of the appendix (arrows) had recovered significantly. Periappendiceal mesenteric fat change had almost resolved.

Emphysematous cholecystitis is caused by gas-forming bacteria such as Clostridium perfringens, Escherichia coli, and Klebsiella and is more likely to occur in diabetic patients[64]. The presence of gas within gallbladder wall or lumen is key for radiologic diagnosis (Figure 14A). Intraluminal gas produces dirty acoustic shadowing with comet-tail or ring-down artifact on US (Figure 14B). This may resemble a contracted gallbladder filled with gallstones or porcelain gallbladder[65]. CT is the most sensitive modality for emphysematous cholecystitis, capable of pinpointing the precise location of gas.

Lata Nott is an attorney with expertise in the intersection of law, technology, and expression. She is a Fellow for the First Amendment at the Freedom Forum, an organization dedicated to fostering First Amendment freedoms for all.

Dr. Jellinek and Dr. Murphy have published more than fifty papers validating the PSC and exploring its use in a wide variety of pediatric and mental health settings. The PSC is a 35-item questionnaire used to measure overall psychosocial functioning in children and adolescents that has been translated into more than two dozen languages, a youth self-report and a brief 17-item versions for parents and youth. All versions of the PSC are available for free in the "PSC Forms" section of this page. 2b1af7f3a8