Giant coronary aneurysms in Kawasaki disease

Case contributed by Dr David Cuevas

Presentation

Retroauricular adenopathies, conjunctival erythema, desquamation and strawberry tongue (5 years ago). Occasional chest pain. Denies an established diagnosis of any cardiac disease.

Patient Data

Age: 15 years
Gender: Female

Giant coronary aneurysms of the right and anterior descending coronary artery. 

A coronary aneurysm is considered giant when its absolute diameter its > 8 mm or has a z score >10.

The proximal right coronary artery maximum diameter of 16 mm, as a reference, it appears larger than the descending aorta. 

Notice a filling defect of the right coronary artery, most likely due to a thrombus, which appears larger than it actually is due to slow flow effect (often seen in pseudo thrombus of atrial appendages). A late acquisition is usually useful to confirm its presence. 

DSA (angiography)

Giant coronary aneurysms of the right and anterior descending coronary artery. 

Nuclear medicine

Negative to ischemia, normal stress test. 

Case Discussion

One of the most important complications of Kawasaki disease is the development of coronary aneurysms.

The patient didn't receive early immunoglobulin treatment due to a delay in its diagnosis, leading to an irreversible coronary aneurysm. This patient is currently under antithrombotic management. 

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Case information

rID: 67499
Published: 29th May 2019
Last edited: 1st May 2020
Inclusion in quiz mode: Included
Institution: Nucleo Diagnostico Avanzado