A 12 y/o boy with history of fever, skin rash strawberry tongue

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Doctor's Information

Name : Ali
Family : Mohammadzadeh
Affiliation :Radiology Department,RjaeeHospital,TUMS
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Shima Hedaiaty Far

Case Section

Cardiovascular

Patient's Information

Gender : Male
Age : 12

Clinical Summary

12 y/o boy with history of fever, skin rash strawberry tongue

Imaging Findings

Aneurismal dilation of left main coronary artery and proximal and mid part of right coronary artery are noted in axial images of CT angiography and volume rendering technique (VRT) images.

Differential Diagnosis

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Final Diagnosis

coronary artery aneurysms developed after kawasaki disease

Discussion (Related Text)

Kawasaki disease is characterized by an acute illness with fever, conjunctivitis, edema of the hands and feet, and an erythematous rash on the trunk, palms, and soles. Red, dry mucous membranes, fissures about the mouth, lymphadenopathy, leukocytosis, and an elevated erythrocyte sedimentation rate are also common. In the acute phase, little evidence of cardiac involvement is identified. Later, coronary thromboarteritis leads to aneurysmal dilatation of the coronary arteries, coronary thrombosis, left ventricular ischemia and dysfunction, myocardial infarction, and rarely, death.Acutely, the heart appears normal. Later, with coronary arteritis, cardiomegaly and congestive heart failure (CHF) may be seen. Calcified coronary artery aneurysms may be seen in the course of the right and left coronary arteries Aneurysmal dilatation ofthe proximal coronary arteries may be identified in the later stages of the illnessin 15% to 20% of patients. Cardiac dysfunction may also be determined. Aortography and coronary arteriography may occasionally be necessary to define the extent of coronary artery involvement in patients with left ventricular dysfunction. The prognosis is good with aspirin and gamma globulin therapy. The coronary arteries may remodel with resolution or decrease in size of saccular or fusiform aneurysms.

References

Jerald P. Kuhn, Thomas L. Slovis,Jack O. Haller: Caffey's Pediatric Diagnostic Imaging, 3rd ed. Philadelphia: Mosby, 2004.
Lane F.Donnelly, MD... [et al.]:Diagnostic imaging. Pediatrics, 1st ed. Salt Lake City, Utah: Amyrsis, 2005.