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(Circulation. 1998;98:92-93.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Giant Coronary Aneurysm of Kawasaki Disease Developing During Postacute Phase

Tomio Kobayashi, MD; Katsuhiko Sone, MD; Makoto Shinohara, MD; Takashi Kosuda, MD; ; Toshihiro Kobayashi, MD

From the Department of Cardiology, Gunma Children's Medical Center, and the Department of Pediatrics, Gunma University School of Medicine (Toshihiro Kobayashi), Gunma, Japan.

Correspondence to Tomio Kobayashi, MD, The Department of Cardiology, Gunma Children's Medical Center, 779 Hokkitsu, Gunma 377, Japan.

The patient suffered from Kawasaki disease at 5 months of age. The first angiography, performed 14 months after the onset of disease, showed a right coronary aneurysm with a maximal diameter of 6 mm and normal left coronary artery (Figure 1). Dipyridamole and propranolol were given as antiplatelet therapy and for reduction of myocardial oxygen consumption, respectively. The second angiography, performed 6 years later, revealed enlargement of the right coronary aneurysm, with a maximal diameter of 15 mm (Figure 2). Treatment with dipyridamole and propranolol was continued. Ten years later, when the patient was 17 years old, the chest radiograph showed bulging of the right cardiac border. MRI demonstrated a giant coronary aneurysm (Figure 3). The findings of the ECG did not indicate myocardial ischemia. The third angiography, performed at 18 years of age, showed a giant right coronary aneurysm with a maximal diameter of 86 mm and normal left coronary artery (Figure 4). Because of the imminent risk of rupture, aortocoronary bypass with saphenous vein graft and aneurysmectomy were performed. Pathological studies of the coronary aneurysm showed marked intimal thickening due to fibrocellular proliferation, disappearance of the elastica interna, and thickening of the media (Figure 5).

View larger version (137K): [in this window] [in a new window]   Figure 1. First angiography shows right coronary aneurysm with a maximal diameter of 6 mm.

View larger version (153K): [in this window] [in a new window]   Figure 2. Second angiography, performed at 7 years of age, shows enlargement of right coronary aneurysm, with a maximal diameter of 15 mm.

View larger version (114K): [in this window] [in a new window]   Figure 3. MRI (spin-echo image) shows giant coronary aneurysm compressing right ventricle. AN indicates aneurysm; LV, left ventricle; and RV, right ventricle.

View larger version (113K): [in this window] [in a new window]   Figure 4. Third angiography (digital subtraction angiography), performed at 18 years of age, shows even larger right coronary aneurysm and normal left coronary artery. No filling defect in aneurysm suggestive of thrombus is noted.

View larger version (116K): [in this window] [in a new window]   Figure 5. Microscopic view of wall of coronary aneurysm shows marked intimal thickening, disappearance of elastica interna, and thickening of media. Victoria blue–van Gieson staining. Magnification x100.

In general, coronary aneurysms of mild to moderate size (<8.0 mm) resulting from Kawasaki disease regress, probably because of intimal thickening, whereas giant aneurysms progress to become obstructive lesions because of thrombus formation. Enlargement of a coronary aneurysm after the acute phase in Kawasaki disease is an extremely rare phenomenon.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kobayashi, T. Articles by Kobayashi, T. Search for Related Content PubMed PubMed Citation Articles by Kobayashi, T. Articles by Kobayashi, T. Pubmed/NCBI databases Medline Plus Health Information Kawasaki Disease