PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. On Saturday, October 9, 2021 at the 2021 Virtual National Conference and Exhibition I presented the ten finalists as a single video presentation. This is one of those ten finalist cases.

This case was submitted by Cassandra Koid Jia Shin, MD a Pediatric Emergency Medicine Fellow from Seattle Children’s in Seattle, Washington. She was assisted by Stephanie Pryor, MD and Jeffery Otjen, MD.