Giant Coronary Artery Aneurysms in Kawasaki Disease
A 5-month-old boy presented with a 3-week history of intermittent high-grade fevers and previous treatment for a presumptive pneumonia. Retrospectively, a strawberry tongue, bilateral conjunctival injections, and a cervical lymph-adenopathy had initially been present. His physical examination was remarkable for a grade 1/6 systolic ejection murmur at the left midsternal border. The ECG showed sinus tachycardia and nonspecific J-point elevations in the lateral chest leads. Echocardiography displayed a pericardial effusion and giant coronary artery aneurysms (Figure 1). An area suspicious for dissection (Figure 2, arrow) was found to be a markedly dilated but intact conal branch of the right coronary artery by biplane aortography (Figure 3, arrow). The fever resolved after a single dose of intravenous immunoglobulin. Aspirin and warfarin were started to prevent coronary thrombus formation. The subsequent clinical course has thus far been uneventful, without any signs of myocardial ischemia.