The AAP Section on Emergency Medicine’s Visual Diagnosis Competition

Submissions for the 2021 PEMPix competition will be open in May. Stay tuned for more details soon. And what will the hybrid program for the Section on Emergency Medicine session at the AAP National Conference and Exhibition actually be like? And what does that mean for PEMPix? Will it be online only or in person? I’ll let you know when I do. Nevertheless, get those excellent cases ready!

Case 1: Ecthyma gangrenosum

Bennett, J. & Dolin, R. & Blaser, M. Skin and Soft Tissue Infection. Mandell, Douglas, and Benntt’s Principles and Practice of Infectious Diseases: 2-Volume Set. 2015.

Biscaye, Stephaie, et al. “Ecthyma Gangrenosum, a Skin Manifestation of Pseudomonas Aeruginosa Sepsis in a previously Healthy Child.” Meidcine, vol. 96, no. 2, 2017, doi: 10.1097/md.0000000000005507

Zomorrodi A, Wald ER. “Ecthyma gangrenosum: considerations in a previously healthy child.” Pediatr Infect Dis J, vol. 21, no. 12, 1 Dec. 2002, pp. 1161-1164., doi: 10.1097/00006454-200212000-00016. 

Case 2: Post circumcision phimosis

Baskin LS, Canning DA, Snyder HM, Duckett JW . Treating complications of circumcision. Pediatr Emerg Care. 1996;12(1):62.

Maizels M, Zaontz M, Donovan J, Bushnick PN, Firlit CF. Surgical correction of the buried penis: Description of a classification system and a technique to correct the disorder. JUrol. 1986;136:268–71.

Case 3: Conjunctival papilloma

American Academy of Ophthalmology: Eye Wiki: Conjunctival Papilloma. 

Bailey RN, Guethlein ME. Diagnosis and management of conjunctival papillomas. J Am Optom Assoc. May 1990;61(5):405-12.

Case 4: ADHD medication vasculopathy

American Psychiatric Association Diagnostic and Statistical Manual of Mental   Disorders, 5th edition:DSM-5. Washington: American Psychiatric Association 2013.

Syed RH, Moore TL. Methylphenidate and  Dextroamphetamine Induced Peripheral Vasculopathy.  J Clin Rheumatol, 14(1); 30-33, 2008.

Khouri C, Blaise S, Carpentier P et al. Drug induced Raynaud’s Phenomenon : Beyond β-adrenoceptor blockers. Br J Clin Pharmacol.82 (1);6-16, 2016.

Case 5: Bronchopulmoary sequestration

Adzick, N.S., Management of fetal lung lesions. Clin Perinatol, 2009. 36(2): p. 363-76, x.

Burge, D. and R. Wheeler, Increasing incidence of detection of congenital lung lesions. Pediatr Pulmonol, 2010. 45(1): p. 103; author reply 104.

Davenport, M., et al., Current outcome of antenally diagnosed cystic lung disease. J Pediatr Surg, 2004. 39(4): p. 549-56.

Eber, E., Antenatal diagnosis of congenital thoracic malformations: early surgery, late surgery, or no surgery? Semin Respir Crit Care Med, 2007. 28(3): p. 355-66.

Kunisaki, S.M., et al., Bronchial atresia: the hidden pathology within a spectrum of prenatally diagnosed lung masses. J Pediatr Surg, 2006. 41(1): p. 61-5; discussion 61-5.

Langston, C., New concepts in the pathology of congenital lung malformations. Semin Pediatr Surg, 2003. 12(1): p. 17-37. 

Lau, C.T., et al., Is congenital pulmonary airway malformation really a rare disease? Result of a prospective registry with universal antenatal screening program. Pediatr Surg Int, 2017. 33(1): p. 105-108.

Case 6: Bullous tinea

Goldstein AO, Goldstein BG. Dermatophyte (tinea) infections. UpToDate. 2018. 

Sweeney SM, Wiss K, Mallory SB. Inflammatory Tinea Pedis/Manuum Masquerading as Bacterial Cellulitis. Arch Pediatr Adolesc Med. 2002;156(11):1149–1152. doi:10.1001/archpedi.156.11.1149

Case 7: Medial sternoclavicular dislocation

Antabak et al. Clavicular fractures in children- Circumstances and causes of injury. Lijec Vjesn. 2015 May-Jun;137(5-6):163-7.

Clavicular fractures in Children: The essentials. Orthopaedic Nursing. September/October 2009, Volume 28 Number 5, p 210 – 214.

Morell et al. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop. 2016 Apr 18;7(4):244-50. doi: 10.5312/wjo.v7.i4.244. eCollection 2016 Apr 18.

O’Neill et al. Conservative Management of Paediatric Clavicle Fractures. Int J Pediatr. 2011. PMID: 22187568.

Reed et al. The missed clavicle fracture in children? Emerg Med J. 2006 Jul; 23(7): 581. doi: 10.1136/emj.2005.032961

Salipas et al. Natural history of medial clavicle fractures. Injury. 2016 Oct;47(10):2235-2239. doi: 10.1016/j.injury.2016.06.011. Epub 2016 Jun 6.

Case 8: Superinfected herpes zoster

Diniz, Lilian Martins Oliveira, et al. “Study of Complications of Varicella-Zoster Virus Infection in Hospitalized Children at a Reference Hospital for Infectious Disease Treatment.” Hospital Pediatrics, vol. 8, no. 7, 2018, pp. 419–425., doi:10.1542/hpeds.2017-0086.

Feder, Henry M., and Diane M. Hoss. “Herpes Zoster in Otherwise Healthy Children.” The Pediatric Infectious Disease Journal, vol. 23, no. 5, 2004, pp. 451–457., doi:10.1097/01.inf.0000126901.88982.32.

Katakam, Bhumesh Kumar et al. “A Prospective Study of Herpes Zoster in Children.” Indian journal of dermatology vol. 61,5 (2016): 534-9. doi:10.4103/0019-5154.190121

Case 9: Prostatic utricle cyst

Bates DG., “The Bladder and Urethra”. Caffey’s Pediatric Diagnostic Imaging. Eleventh Edition.  In print. 

Krstic ZD et al. Surgical Treatment of the Mullerian Duct Remnants. Journal Pediatric Surgery, Vol 36, No 6 (June), 2001: pp 870-876

Priyadarshi, Vinod, et al. “Prostatic Utricle Cyst: a Clinical Dilemma.” APSP Journal of Case Reports, EL-MED-Pub, 10 May 2013,

Ramachandra, Mukunda, et al. “Isolated Prostatic Utricle.” Journal of Indian Association of Pediatric Surgeons, Medknow Publications, Oct. 2009,

Varlet, F, et al. “Congenital Dilatation of the Prostatic Utricle. Embryologic Review, Diagnosis and Treatment. Apropos of 2 Pseudo-Tumoral Cases, without Hypospadias.” Annales D’urologie, U.S. National Library of Medicine, 1992,

Case 10: Pneumoparotid

Luaces R, Ferreras J, Patino B, et al.  Pneumoparotid: a case report and review of the literature. J Oral Maxillofac Surg 2008;66(2):362-5.

van Ardenne N, Kurotova A, Boudewyns A. Pneumoparotid: a rare cause of parotid swelling in a 7-year-old child. B-ENT 2011;7(4):297-300.







Check out for PEMPix Classic cases!


Previous PEMPix Cases


Anomalous Left Coronary Artery from the Pulmonary Artery
Budd-Chiari Syndrome
Hemorrhagic Pericardial Cyst
Internal lilac pseudoaneurysm
Intestinal foreign body (rubber ducky)
Majocchi granuloma
Migrating pharyngeal foreign body
Norwegian Scabies
Palatal foreign body
Paraspinal mass
Tension Gastrothorax


2,4 – Dinitrophenol Toxicity
Bednar’s apthae
Benign Granular Cell Tumor
Incontinentia Pigmenti
Mesenteric Cyst
Morgagni Hernia
Pericardial Effusion
Speckled Lentiginous Nevus
Synovial Sarcoma
Temporal Artery Aneurysm
Thrombosed Arterial Aneurysm


Hirudinea (leech exposure)
Lichen Striatus
Pulmonary Metastases
Secondary Syphilis Sporotrichosis Tick Paralysis Toxic Epidermal Necrolysis
Vernal Conjunctivitis


Behçet Syndrome
Cervical Lung Herniation
Erythema Multiforme
Incarcerated inguinal hernia
Langerhans cell Histiocytosis
Lipschütz ulcer
Metabolic bone disease
Oral Lymphangioma
Papular purpuric gloves and socks syndrome
Phlyctenular Keratoconjunctivitis
Prolapsed ureterocele
Scabies with parapharyngeal abscess
Septicemia with Septic Emboli


Acrodermatitis Enteropathica
Disseminated Staphylococcal Disease
Eyeball Luxation
Garré’s Osteomyelitis
Lisfranc Fracture
Persistent Omphalomesenteric Duct
Subcutaneous Fat Necrosis
Vulvar Aphthosis
Wilm’s Tumor

2018 PEMPix Winners

Audience Award

Palatal Foreign Body
Drew Taylor Louden
Seattle Children’s

2018 Judge’s Award

Budd-Chiari Syndrome
Tucker Anderson, Mindy Longjohn, Linda Myers
LeBonheur Children’s Hospital

2017 PEMPix Winners

Audience Award

Speckled Lentiginous Nevus
Laura Sartori, MD Christopher Stark, MD
Monroe Carell Jr. Children’s Hospital at Vanderbilt

Judges Award

2,4 – Dinitrophenol Toxicity
Michael Chary, MD, PhD Yoneda Nao, MD Ameer Hassoun, MD
Department of Pediatric Emergency Medicine New York-Presbyterian Queens