Giant aortic arch aneurysm complicating Kawasaki′s disease

Hakim, Kaouthar; Boussada, R.; Chaker, Lilia; Ouarda, Fatma

doi:10.4103/0974-2069.140845

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…However, many case reports in the current era have also revealed that SAAs are almost always associated with giant CAAs. [5][6][7]11,14,16,22,23 With these data, it is reasonable to assume that even screening patients with giant CAAs may in part reflect the incidence of SAAs in all patients with KD.…”

Section: Discussionmentioning

confidence: 99%

Systemic Artery Aneurysms and Kawasaki Disease

Zhao

Chu

et al. 2019

Pediatrics

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BACKGROUND: Coronary artery aneurysms (CAAs) are a well-known complication of Kawasaki disease (KD), but there are no data on incidence or outcomes of systemic artery aneurysms (SAAs) in the current era. METHODS: From April 1, 2016, to March 31, 2019, we screened for SAAs in 162 patients with KD at risk for SAAs with magnetic resonance angiography or peripheral angiography and analyzed incidence and early outcomes of SAAs. RESULTS: Twenty-three patients had SAAs, demonstrating an incidence of 14.2% (23 of 162) in patients who were screened at 1 month after onset. The proportion of patients with SAAs was estimated to be 2% (23 of 1148) of all patients with KD. The median age at onset of KD with SAAs was 5 months. All patients with SAAs had CAAs, with z scores .8. Of patients with giant CAAs, 38.6% (17 of 44) had SAAs. A total of 129 SAAs occurred in 17 different named arteries. The most common sites for SAAs were the axillary (18.6%), common iliac (12.4%), and brachial (11.6%) arteries. During a median follow-up time of 6 months, 92.9% (79 of 85) of SAAs had some degree of regression, with 80% (68 of 85) of SAAs returning to normal. The overall regression rate was higher for medium to large SAAs than for medium to giant CAAs. CONCLUSIONS: Although the incidence of SAAs may not be as dramatically reduced as we expected compared with previous data, SAAs have a high regression rate during short-term follow-up. WHAT'S KNOWN ON THIS SUBJECT: Studies from the 1980s revealed that systemic artery aneurysms (SAAs) may occur in 0.8% to 2% of patients with Kawasaki disease at 3 months after onset. It is speculated that SAAs are now much less common than before. WHAT THIS STUDY ADDS: SAAs occur in 14.2% of patients at risk for SAAs at 1 month after onset, giving an estimated proportion of patients with SAAs as 2% of all patients with Kawasaki disease. SAAs have a high regression rate during short-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Systemic Artery Aneurysms and Kawasaki Disease

Zhao

Chu

et al. 2019

Pediatrics

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“…Actually, in previous cases, surgical or interventional treatment of aneurysms has been reported in only a few cases. Considering the risk of rupture, two KD patients separately complicated with giant aortic arch aneurysms and thoracoabdominal aortic aneurysms underwent aneurysm resection and aortic reconstruction with artificial conduits [ 13 , 14 ]. Another two cases of KD separately with hepatic and intercostal aneurysms were treated with percutaneous coil embolization, in order to maintain local artery circulation [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

et al. 2021

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Background Kawasaki disease (KD) is a systemic vasculitis that predominantly affects medium-sized arteries. In addition to well-known coronary artery aneurysms (CAAs), peripheral systemic artery aneurysms (SAAs) have also been sporadically reported. In the literatures, SAAs occurred mainly in untreated, intravenous immunoglobin (IVIG)-resistant, or severe refractory KD, and thrombotic events in SAAs were rarely reported. Case presentation A 10-month-old boy with a history of KD was referred to our hospital for suspected pseudoaneurysm of the axillary arteries. Four months prior to presentation, he had persistent fever, conjunctival congestion, and rash. On the 10th day of fever echocardiogram showed biliteral CAAs. He was then diagnosed with KD and given IVIG 2 g/kg and aspirin at a local hospital. His fever and symptoms soon subsided and he was discharged with low dose aspirin and dipyridamole. One month prior to presentation, his parents incidentally palpated swellings in his bilateral axillae. On admission, physical examination revealed a pulsatile swelling in his right axilla and a non-pulsatile swelling in the left with impalpable left brachial and radial pulses, cooler and less active left upper limb than the right one. While the pulses of other three limbs were normal. Ultrasound examination revealed giant bilateral axillary artery aneurysms (AAAs) with massive thrombus in the left. Angiography confirmed giant bilateral AAAs with left AAAs completely occluded and fine collateral vessels connecting to the distal brachial artery, in addition to giant bilateral multiple CAAs without stenoses. The patient was given intravenous prostaglandin for 10 days to allow for formation of collateral circulation, as well as aspirin, low molecular weight heparin (which was switched to warfarin before discharge) and metoprolol. At discharge, the temperature and movement of his left upper limb improved significantly. On follow-up at 7 months, his left upper limb further improved and was similar to the right with no occurrence of cardiovascular events. The images of CAAs and AAAs on echocardiogram and computerized tomography remained the same. Conclusions This case highlights the importance of evaluating peripheral SAAs in KD patients with CAAs, even if their course of treatment appears smooth. For both large non-aortic SAAs and CAAs in KD patients, antithrombotic therapy is of utmost importance.

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“…In previous cases, surgical or interventional treatment of aneurysms has been reported only in few cases. Two KD patients separately complicated with giant aortic arch aneurysms and thoracoabdominal aortic aneurysms underwent aneurysm resection and aortic reconstruction with arti cial conduits considering the risk of rupture (12,13). Another two cases of KD separately with hepatic and intercostal aneurysms were treated with percutaneous coil embolization (14,15).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Giant Axillary Artery Aneurysms with Left Complete Embolism in Intravenous Immunoglobulin-Sensitive Kawasaki Disease: A Case Report

Yang

et al. 2021

Preprint

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Background: Kawasaki disease (KD) is a systemic vasculitis that predominantly affects medium-sized arteries. In addition to well-known coronary artery aneurysms (CAAs), peripheral systemic artery aneurysms (SAAs) have also been sporadically reported. In the literatures, SAAs occurred mainly in untreated, intravenous immunoglobin (IVIG)-resistant, or severe refractory KD, and thrombotic events in SAA were rarely reported.Case presentation: A 10-month-old boy with history of KD was referred to our hospital for suspected pseudoaneurysm of the axillary arteries. Four months prior to presentation, he had recurrent fever, conjunctival congestion, and rash. On the 10th day of fever echocardiography showed biliteral CAAs. He was then diagnosed with KD and given IVIG 2g/kg and aspirin at a local hospital. His fever and symptoms soon subsided and he was discharged with low dose aspirin and dipyridamole. One month prior to presentation, his parents incidentally palpated swellings in his axillae bilaterally. On admission, physical examination revealed a pulsatile swelling in his right axilla and a non-pulsatile swelling in the left. His left brachial and radial pulses were not palpable, while the pulses of other three limbs were normal. His left upper limb was cooler and less active compared to the right. Ultrasound examination revealed bilateral giant axillary artery aneurysms (AAAs) with massive thrombus in the left. Angiography confirmed bilateral giant AAAs with left AAAs completely embolized and fine collateral vessels connecting to the distal brachial artery, in addition to bilateral multiple giant CAAs without stenoses. The patient was given intravenous prostaglandin for ten days to allow for formation of collateral circulation, as well as aspirin, low molecular weight heparin (which was switched to warfarin before discharge) and metoprolol. At discharge, the temperature and movement of his left upper limb improved significantly. On follow-up at three months, his left limb improved and was similar to the right with no cardiovascular event having occurred. The images of CAAs and AAAs on ultrasound and computerized tomography remained the same.Conclusions: This case highlights the importance of evaluating peripheral SAAs in KD patients with CAA, even if their clinical course appears uncomplicated. For both large non-aortic SAAs and CAAs in KD patients, antithrombotic therapy is of utmost importance.

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Giant aortic arch aneurysm complicating Kawasaki′s disease

Cited by 7 publications

References 8 publications

Systemic Artery Aneurysms and Kawasaki Disease

Systemic Artery Aneurysms and Kawasaki Disease

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

Bilateral Giant Axillary Artery Aneurysms with Left Complete Embolism in Intravenous Immunoglobulin-Sensitive Kawasaki Disease: A Case Report

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