Over the years many amazing cases have been presented during the PEMPix presentation at the American Academy of Pediatrics’ annual national Conference and Exhibition during the Section on Emergency Medicine Sessions. PEMPix Classic is a new featured series on PEMBlog that will highlight some of those classic cases.

The Case

A seven week old full term female presents with swelling of right labia. Parents noted it just a few hours before arrival to the ED. Coincident with the swelling her parents have noted increased fussiness and spitting up. She has been afebrile, with normal urine output and stools. Parents also deny trauma.

On examination she is afebrile, grunting and somewhat sleepy. Her abdomen is firm and tender. She also has notable swelling in her right labia.

An abdominal X-Ray was then obtained…

What is the diagnosis?

A. Non accidental trauma
B. Incarcerated inguinal hernia
C. Infectious lymphadenitis
D. Group A Strep cellulitis with sepsis
E. Rapidly proliferating non-Hodgkin lymphoma