Coronary artery aneurysms due to Kawasaki disease: diagnosis with ultrafast CT.

Abstract

Coronary artery aneurysms are the most serious complication of Kawasaki disease, and periodic screening examinations are necessary. Two-dimensional (2D) echocardiography represents the standard screening method; however, visualization of the distal coronary arteries is often limited. This report describes the complementary role of ultrafast computed tomography (CT) with 2D echocardiography in the evaluation of coronary artery aneurysms resulting from Kawasaki disease (mucocutaneous lymph node syndrome). Six pediatric patients with coronary aneurysms were examined with 2D echocardiography and ultrafast CT. Ten of 11 lesions were detected with ultrafast CT. The one missed coronary artery aneurysm was one of two contiguous aneurysms. Because of intersection thickness these two discrete aneurysms were interpreted as a solitary aneurysm. Ultrafast CT allowed detection of one aneurysm not initially visualized with echocardiography. In conclusion, ultrafast CT was found to be an effective complementary procedure with 2D echocardiography for noninvasively evaluating coronary artery aneurysms occurring as sequelae of Kawasaki disease.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

“…Ultrafast CT also has been used to assess coronary aneurysms. 111,112 Further larger studies in patients with Kawasaki disease are needed to establish the reliability of MRA and ultrafast CT for the detection of coronary artery aneurysms and stenoses in distal segments, as well as for the presence of collateral circulation.…”

Coronary artery aneurysms detected with ultrafast computed tomography

“…A few studies [2][3][4] showed coronary artery aneurysms demonstrated with ultrafast CT. Frey et al [2] showed that 9 of the 10 coronary artery aneurysms due to Kawasaki disease that demonstrated by coronary angiography were detected with ultrafast CT. Coronary angiography can demonstrate the number, location, and configuration of coronary artery aneurysms. However, mural thrombus may obscure the true contour of those aneurysms with angiography.…”

“…Ultrafast computed tomography (CT) provides a noninvasive technique for evaluating cardiac function and anatomy [1]. This modality can reveal the true contour of coronary aneurysms, even those that are filled with thrombus [2][3][4]. This article describes coronary artery aneurysms that could not be detected by coronary angiography but could be visualized with ultrafast CT.…”

Kawasaki disease: role of coronary CT angiography

“…KD is an acute febrile illness due to multi-organ vasculitis characterized by fever, desquamative skin rash, conjunctival and pharyngeal injection, swelling of the hands and feet and cervical lymphadenopathy [2,3]. Despite treatment with intravenous immunoglobulin and high dose aspirin, coronary artery aneurysms are seen in~25% of children with KD, especially those under five years of age.…”

“…The initial detection and follow-up of coronary artery aneurysms is important for long term prognosis and outcome in children with KD. Although, echocardiography can be used to assess proximal coronary arterial aneurysms, cardiac catheterization with coronary angiography is considered the gold standard [3,4]. However, the recent advances in multislice CT technology have made it possible to noninvasively diagnose and sequentially follow patients with KD who have coronary artery aneurysms.…”