Images in Clinical Medicine

Giant Coronary-Artery Aneurysm in Kawasaki's Disease

Graeme F. Porter, M.B., Ch.B., and Thomas L. Gentles, F.R.A.C.P.

N Engl J Med 2001; 345:98July 12, 2001

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Figure 1 A 14-year-old girl in whom Kawasaki's disease was diagnosed at the age of 2 years had a posterior myocardial infarction at the age of 3 years. When we saw her she had signs of mild mitral regurgitation but no symptoms. Transthoracic echocardiography demonstrated a giant aneurysm involving the left main coronary artery. On exercise testing she had ST-segment depression in leads I, II, V₄, and V₅. Exercise echocardiography confirmed the presence of severe, reversible ischemia of the midportion and distal portion of the anterior wall, apex, distal septum, and lateral wall of the left ventricle. A chest film showed an area of calcification at the upper border of the left ventricle (arrow in Panel A). Selective angiography of the left coronary artery showed a large aneurysm of the left main coronary artery with stenosis of 80 percent of the luminal diameter at the origin of the left anterior descending coronary artery (arrow in Panel B). The circumflex coronary artery was occluded proximally (not shown) but filled by means of collaterals from the right coronary artery (arrow in Panel C). The patient underwent surgical revascularization because of the poor prognosis associated with stenosis of a giant aneurysm in a patient with Kawasaki's disease. Three years after surgery, the patient was asymptomatic, and exercise echocardiography demonstrated no inducible ischemia.

Graeme F. Porter, M.B., Ch.B.
Thomas L. Gentles, F.R.A.C.P.
Green Lane Hospital, Auckland, New Zealand