Multiple Systemic Arterial Aneurysms in Kawasaki Disease

HomeRadioGraphicsVol. 42, No. 3 PreviousNext Cases from the Cooky JarFree AccessMultiple Systemic Arterial Aneurysms in Kawasaki DiseaseTushar Garg, Ciléin Kearns, Esther Kim, David H. Ballard Tushar Garg, Ciléin Kearns, Esther Kim, David H. Ballard Author AffiliationsFrom The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md (T.G.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (E.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B.).Address correspondence to D.H.B. (e-mail: [email protected]).Tushar GargCiléin KearnsEsther KimDavid H. Ballard Published Online:Mar 25 2022https://doi.org/10.1148/rg.220002MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Kawasaki disease (KD) is a medium- and small-sized artery vasculitis syndrome in pediatric patients (1). Coronary artery aneurysms are the most recognized complication of KD, seen in approximately 25% of patients without immunoglobulin treatment (2) (Figs 1, 2; Movie 1). Systemic arterial aneurysms (SAAs) are uncommon, with a prevalence of 0.8%–2% at 3 months after the onset of KD (3). The diagnosis of SAAs can be suspected on the basis of the patient history and clinical examination findings (eg, pulsatile mass and pulse irregularities) and confirmed with CT or MR angiography (4). Early diagnosis and treatment are important to prevent complications such as thrombosis, systemic embolization, and aneurysm rupture. SAAs have good long-term outcomes when the diagnosis is made early and prompt medical therapy is initiated; 93% of SAAs show some regression, and 80% of SAAs regress to normal over time (3). Radiologists should be aware of SAA as an uncommon manifestation of KD and incorporate this entity into their search pattern as they evaluate patients with KD.Figure 1: Kawasaki disease in a 6-month-old girl. (A) Axial contrast-enhanced CT angiographic image of the chest and left upper extremity demonstrates a large left anterior descending artery aneurysm (arrow) and a left brachial artery aneurysm (dashed box). (B–D) Maximum intensity projection coronal (B) and sagittal (C) reconstructions and oblique coronal virtual cinematicrendering (D) highlight multiple systemic arterial aneurysms and a left anterior descending coronary artery aneurysm (white arrow in B and D). Aneurysms of the common and internal iliac arteries (arrowheads), multiple lumbar artery aneurysms (yellow bracket in B and C), an aneurysm of the inferior mesenteric artery (yellow arrow in C), and aneurysms of the left axillary and brachial arteries (dashed box in D) are all seen in this patient. A catheter terminating in the right external iliac artery is shown (black arrow in B and D).Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: Illustration of cardiovascular complications in patients with Kawasaki disease shows multiple systemic arterial aneurysms in the branches of the aortic arch paired with coronary artery aneurysms. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2022.)Figure 2:Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1. Rotating virtual cinematic rendering demonstrates multiple systemic arterial aneurysms.Download Original Video (4.4 MB)Disclosures of Conflicts of Interest.— C.K. Editorial board member of RadioGraphics. D.H.B. Editorial board member of RadioGraphics.C.K. and D.H.B. have reported disclosures (see end of article); all other authors have disclosed no relevant relationships.References1. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017;135(17):e927–e999 [Published correction appears in Circulation 2019;140(5):e181–e184]. Crossref, Medline, Google Scholar2. Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation 1996;94(6):1379–1385. Crossref, Medline, Google Scholar3. Zhao QM, Chu C, Wu L, et al. Systemic artery aneurysms and Kawasaki disease. Pediatrics 2019;144(6):e20192254. Crossref, Medline, Google Scholar4. Tsujioka Y, Handa A, Nishimura G, et al. Multisystem imaging manifestations of Kawasaki disease. RadioGraphics 2022;42(1):268–288. Link, Google ScholarArticle HistoryReceived: Jan 12 2022Accepted: Jan 14 2022Published online: Mar 25 2022Published in print: May 2022 FiguresReferencesRelatedDetailsRecommended Articles Abnormalities of the Coronary Arteries in Children: Looking beyond the OriginsRadioGraphics2017Volume: 37Issue: 6pp. 1665-1678Kawasaki Disease with Unusual Systemic Arterial AneurysmsRadiology2022Volume: 306Issue: 3Coronary Artery Aneurysm Formation: Kawasaki Disease versus AtherosclerosisRadioGraphics2018Volume: 38Issue: 1pp. 10Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology ArchivesRadioGraphics2018Volume: 38Issue: 1pp. 11-36IgG4-related Cardiovascular Disease from the Aorta to the Coronary Arteries: Multidetector CT and PET/CTRadioGraphics2018Volume: 38Issue: 7pp. 1934-1948See More RSNA Education Exhibits Image Findings of Aneurysms in ChildrenDigital Posters2019Vasculitides from Head to Toe: Multimodality Imaging Diagnosis, Treatment, and ManagementDigital Posters2022The Prevalence And Imaging Features Of Extra-coronary Arteriopathies In Patients With Spontaneous Coronary Artery Dissection. 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