2nd Place EMage Winner: What’s on the Tip of the Tongue?

Adam Garibay, MD; Kelly Winters, MSN, RN, CPNP, CNS ; Tabitha Cheng, MD,; Supriya Sharma, MD; Manpreet Singh, MD, MBE

Pediatric Emergency Department, Department of Emergency Medicine, Harbor-UCLA Medical Center

Case Presentation: Tongue Depressor

A 5-year-old male presented to the pediatric ED due to a growth on the tip of his tongue.  The patient’s mother was worried as the mass had been increasing in size and was bleeding, causing decreased oral intake. Further history revealed progressive tongue swelling and increasing growth of the mass over a three-month period. Upon further questioning, it was presumed that the mass formed after a traumatic injury where he bit his tongue. Prior to this visit he presented to three other EDs and was unable to receive a referral to Otolaryngology due to insurance issues. read more

3rd Place EMage Winner: Teenager With Swollen Eye

Chloe Knudsen-Robbins
University of Pittsburgh Medical Center

Nelson Bansil
CHOC Children’s

A 13-year-old-female with a past medical history of Crohn’s disease, presented to the Pediatric Emergency Department (PED) with 8 hours of headache, left eye pain and periorbital swelling. She denied trauma or fevers.

Exam demonstrated left periorbital swelling with ecchymosis and tenderness to palpation. Swelling prevented assessment. Intra-ocular pressure (IOP) was unobtainable.

Emergent ophthalmology consult was obtained and a lateral canthotomy with cantholysis was performed in the PED.  CT of the orbits showed left periorbital swelling with diffuse enlargement of the recti muscles.  Diagnosis was determined to be most consistent with orbital compartment syndrome (OCS) secondary to orbital inflammatory pseudotumor (OIP) as a complication of IBD. read more

1st Place EMage Winner-Infant With a Strange Rash

Rob Grell, MD
Division of Pediatric Emergency Medicine
Department of Pediatrics
Emory University School of Medicine

7-month-old male with no past medical history presented to the Pediatric Emergency Department (PED) for 4 months of rash and decreased urine output. Mom reports that she had initial sought medical care 4 months ago, but despite treatment and repeated reassurance, the rash has worsened. Over the last 24 hours prior to presentation, the rash became firm, indurated, and more edematous. The rash was initially localized to the diaper region, but recently spread inferiorly to the lower extremities and superiorly to the abdomen. Mom reports failure of treatment with topical steroids and only transient improvement when treated with oral steroids. Working diagnosis at the time of presentation was granuloma gluteale infantum. read more

1st Place EMage Winner: Helluva Uvula

Evan Laveman, M.D. ; Kelly Kelley, MSN, RN, ; Christopher Redgate, MD, MS,

Pediatric Emergency Department, Department of Emergency Medicine, Harbor-UCLA

Case Presentation: Helluva Uvula

A 16-year-old male with no past medical history presented to the Pediatric Emergency Department (PED) for 4 months of nasal congestion worsening over the past month. He immigrated from Honduras with his father 20 days ago and over this time noticed a decreased ability to breath through his nose. Most troubling, he started to develop foul smelling nasal discharge mainly through his left nare. His only medical contact had been at a U.S. clinic when he first arrived where he was prescribed a nasal spray and cetirizine with no relief. He felt moderate sinus pressure but denied weight loss, fevers, chills, headache or vision changes. read more

2nd Place EMage Winner-Bronchial Atresia in an 18‐Month‐Old

Tanya Dall, MD; Tyler Ayalin, MD
Dr. Dall UCI/CHOC ‐ Children’s Hospital of Orange County; Dr. Ayalin ‐ CHOC

An 18-month-old male with no previous medical history presented to the pediatric ED during the summer for 4 months of cough. The parents described the cough as intermittent, lasting weeks at a time, before resolving and then recurring. The cough was associated with intermittent shortness of breath. He had been seen several times in the ED and by his pediatrician and was pending an outpatient ENT workup for intermittent stridor. His parents brought him to the ED because of a choking episode with perioral cyanosis while feeding. The initial CXR below demonstrated a distinct right upper lobe hyperlucency. Working diagnoses included asthma, airway obstruction, and foreign body. Bilateral decubitus xrays were performed, suggesting air trapping. A CT chest was performed that raised concern for bronchial atresia of the right upper lobe. read more