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A boy aged 2 years 10 months was admitted to the hospital because of high fever for three days, a rash over the trunk, oedema, redness of the palms without peeling skin, conjunctivitis affecting both eyes, redness of the lips, reddened throat with strawberry-coloured tongue, and swollen lymph nodes in the neck region.
The diagnosis of acute Kawasaki disease was suspected and an early echocardiography was performed which initially showed normal sized coronary arteries, normal function and wall motion of both ventricles, no pericardial effusion, and no valvar dysfunction.
In spite of immediate treatment with intravenous γ globulin (using a single dose of 2 g/kg) and aspirin (10 mg/kg) daily, a giant aneurysm (12 mm in diameter) of the proximal right coronary artery (panels A and B), and three fusiform aneurysms of the left main coronary artery including the proximal part of the left anterior descending artery (panels C and D) developed, as seen on follow up echocardiography 10 days later. There were no wall motion disorders, no thrombus formation, and no other lesions. Coronary angiography confirmed these findings, and no significant coronary artery obstruction was visible.
Giant coronary artery aneurysms are seen in 0.5–1% of adequately treated children with Kawasaki disease. To avoid thrombus formation in the giant aneurysm of the right coronary artery we decided to treat the patient with long term aspirin together with coumadin. The outcome following 20 months of follow up has been astonishing and favourable to date. Elective follow up catheterisation is planned in the ensuing months.