Jurnal
Forum Pencitraan
Kardiologi Indonesia
J Kardiol Indones. 2013;34:133-5
ISSN 0126/3773
Giant Coronary Artery Aneurysms in Kawasaki
Disease Detected by Multi Detector Computed
Tomographic
Oktavia Lilyasari, Poppy S Roebiono, Radityo Prakoso, Anna Ulfah Rahajoe,
Indriwanto Sakidjan, Ganesja M Harimurti
Kawasaki disease is an acute, self -limited vasculitis of unknown etiology that occurs predominantly in infants and young
children. The major sequele of Kawasaki disease are related to the coronary arterial system. Cardiac imaging is a critical part in
evaluation of all patients with suspected Kawasaki disease. Multi Detector CT (MDCT) provides a safe non-invasive approach
to accurately delineate coronary artery anatomic structure. We report a case of a 6 years old boy with history of Kawasaki
disease. Multi detector CT scan showed giant aneurysm at proximal LAD, proximal RCA and medium aneurysm at proximal
LCX. Patient then treated with the anticoagulant therapy.
(J Kardiol Indones. 2013;34:133-5)
Keywords: Kawasaki Disease-Multi Detector CT scan
Case Report Left Anterior Descending (LAD) and Left Circumflex
(LCX) measuring 4mm in diameter and Right Coronary
A
6 years old boy was diagnosed with Artery (RCA) measuring 4.5mm in diameter.
Kawasaki disease 3 months before admission For further evaluation we performed MDCT on
and previously treated with intravenous this patient. The patient was asymptomatic at the time
immunoglobulin. The patient was sent to us of the CT examination. Coronary CT angiography is
with suspicion of developing coronary aneurysm. The performed as an electrocardiographically gated contrast
echocardiography examination found dilatation of Left medium-enhanced CT scan of the heart. It showed
Main (LM) 2.7 mm and coronary aneurysm involving normal diameter of LM measuring 2 mm in diam-
eter. The coronary aneurysms involving the proximal
of LAD measuring 8.2 in diameter and 20.6mm in
length, proximal LCX measuring 6.4mm in diameter
Dr. Oktavia Lilyasari, Departemen Kardiologi dan Kedokteran
Alamat korespondensi: and 18.7 mm in length, and proximal RCA measuring
Vaskular FKUI, Pusat Jantung Nasional Harapan Kita. Jakarta. E-mail:
10.9mm in diameter and 30.8 mm in length (Figure
[email protected] 1). Distal part and branches of these coronary arteries
Jurnal Kardiologi Indonesia • Vol. 34, No. 2 • April - Juni 2013 133
Jurnal Kardiologi Indonesia
are normal in diameter (Figure 2). The Patient is cur- Coronary artery aneurysms and ectasia are charac-
rently stable without any clinical symptom and treats terized by an abnormal dilatation of a coronary artery
with the anticoagulant therapy. and aneurysm is a focal dilatation of the vessel. 3 In the
(a) (b) (c)
Figure 1. Contrast enhanced CT demonstrating : (a). A giant aneurysm at the proximal LAD. (b). A
medium aneurysm at the proximal of LCX. (c). A giant aneurysm at the proximal of RCA.
Figure 2. Volume Rendering three-dimensional (3D) coronary arteries show the location and morphol-
ogy of coronary aneurysm.
Discussion last American Heart Association statement, aneurysms
were classified as a small (<5mm internal diameter),
Kawasaki disease is an acute, self -limited vasculitis medium (5-8mm internal diameter), or giant (> 8mm)
of unknown etiology that occurs predominantly in internal diameter. Giant are associated with a greater
infants and young children. First described in Japan morbidity and mortality. Stenosis, thrombosis, or oc-
in 1967 by Tomisaku Kawasaki. Kawasaki disease clusion may develop at either end of the aneurysm.
is characterized by fever, bilateral non-exudative Myocardial infarction from stenosis or thrombosis in
conjunctivitis, erythema of the lips and oral mucosa, the area of an aneurysm is the principal cause of death
changes in the extremities, rash and cervical from Kawasaki disease. 1
lymphadenopathy. Cardiovascular involvement is The major sequalae of Kawasaki disease are related to
the most serious complication. If not treated well, the the cardiovascular and more specifically the coronary
patients have substantially increased risk of developing arterial system. So cardiac imaging is a critical
coronary artery aneurysms. Acute inflammation part in evaluation of all patients with suspected
begins in the intima and adventitia, and then involve Kawasaki disease. Echocardiography is an ideal
the media. Disruption of the elastic lamina begins to non invasive examination and has a high sensitivity
weaken the arterial wall and consequently, coronary and specificity for detection of abnormalities of the
artery aneurysms develop in 15-25% of patients. 1,2 proximal Left Main Coronary Artery (LM) and
134 Jurnal Kardiologi Indonesia • Vol. 34, No. 2 • April - Juni 2013
Lilyasari O et al: Coronary artery aneurysms in Kawasaki disease
Right Coronary Artery (RCA). It is important to coronary angiography represents an ideal non-invasive
recognize the limitation of echocardiography in the imaging modality for diagnosis and follow up of the
evaluation and follow up of patients with Kawasaki coronary arterial complication of Kawasaki disease
Disease. The visualization of coronary arteries as adjunctive modality of echocardiography. Its use
becomes progressively more difficult as a child in the management of Kawasaki disease should be
grows and body size increase. Other modalities such considered.
as angiography, intravascular ultrasound (IVUS),
trans-esophageal echocardiography, cardiac magnetic
Resonance Angiography (MRA) and ultrafast References
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