“Arteries Within the Artery” After Kawasaki Disease
A Lotus Root Appearance by Intravascular Ultrasound
A 26-year-old man underwent cardiac catheterization because of abnormal electrocardiography (QS in leads V1 to V3) and thallium stress scintigraphy (a fixed defect in the anteroseptal wall). The patient had a history of suspected Kawasaki disease with sudden cardiac arrest at the age of 1 year. Coronary angiography showed no significant aneurysm, occlusion, or stenosis but a mild dilatation with a braid-like appearance at the proximal segment of the left anterior descending artery (LAD) (Figure 1). Intravascular ultrasound (IVUS) revealed that this segment was composed of multiple channels. The channels were connected to the septal branch, the diagonal branch, and the distal LAD (Figure 2), suggesting spontaneous recanalization of the thrombotic LAD occlusion due to coronary vasculitis with Kawasaki disease. This lotus root-like appearance detected in vivo by IVUS presumably corresponds to the “arteries within the artery” phenomenon reported in a previous pathological study of Kawasaki disease.
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.
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