Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis

Ruptured mycotic coronary artery aneurysm

“…While congenital diseases and vasculitis like Kawasaki are the most common causes of coronary artery aneurysms in children,4 atherosclerosis is the leading cause in adults 5. Bacterial infections causing coronary artery aneurysm represent less than 3% of all coronary artery aneurysms; however, complications can prove to be fatal 6…”

CT Imaging Findings in Non-Atherosclerotic Coronary Artery Disease

“…CCTA는 관상동맥류의 위치, 크기, 구조, 내강협착, 동반된 혈전 유무 및 석회화 벽 등의 전반적인 관상동맥에 대한 정보를 제공할 수 있어 특히, 에코창에 제한이 있는 경우 초음파보다 더 도움을 받을 수 있다( Fig. 5 ) ( 47 ). 전신 동맥류(systemic aneurysm)가 있는 모든 환자에서 관상동맥류가 확인되었고 다발성 거대동맥류의 빈도가 높아 나쁜 예후를 보였다( 48 ).…”

“…가와사키병에서는 흔히 방추형(fusiform) 동맥류을 보이고 낭포형(saccular) 동맥류는 드물지만 나쁜 예후를 보인다. 급성기 가와사키병에서 6 mm 이상의 관상동맥 확장이 보인 대부분의 환자에서 관상동맥 석회화가 발생하였다( 47 ). 만성기가 되면 관상동맥 협착이 진행되어 심근허혈의 위험성이 증가하는데, 17년 추적관찰 시 20%에 가까운 환자에서 협착이 보고되었다( 49 ).…”

A Case of Incomplete Kawasaki Disease Complicated by Acute Coronary Syndrome Initially Diagnosed on Coronary CT Angiography

“…Complete occlusion of CAA leading to ACS in this patient may have been caused by both the large size of the CAA (i.e., turbulent and stagnant flow) and delayed diagnosis (i.e., no prior use of immunoglobulin therapy, aspirin, or anticoagulation). 1) 2) Using cutting edge techniques that minimize radiation exposure, CCTA was performed with very low radiation dose (<1 mSv) in this patient. 1) 2) The primary imaging tool to evaluate CAA in patients with KD is echocardiography.…”

“… 1) 2) Using cutting edge techniques that minimize radiation exposure, CCTA was performed with very low radiation dose (<1 mSv) in this patient. 1) 2) The primary imaging tool to evaluate CAA in patients with KD is echocardiography. However, echocardiography has important drawbacks such as a limited acoustic window and operator dependency.…”