Computed Tomography Angiography Indications in the Follow-Up of Kawasaki Disease Patients

Parvin  Akbariasbagh; Seyed Reza  Raeeskarami; Massoumeh  Asgarshirazi; Sahar  Naderi; Mehrnaz  Adib

doi:10.18502/jthc.v19i4.17616

Parvin Akbariasbagh Department of Pediatrics, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Seyed Reza Raeeskarami Department of Pediatrics, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Massoumeh Asgarshirazi Department of Pediatrics, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Sahar Naderi Department of Pediatric Rheumatology, Hakim Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mehrnaz Adib Department of Pediatric Rheumatology, Hakim Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v19i4.17616

Keywords: Mucocutaneous lymph node syndrome; Computed tomography angiography; Echocardiography; Myocardial bridging

Abstract

Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a vasculitis that primarily affects young children and results in coronary artery abnormalities. Echocardiography is the standard imaging modality for monitoring KD patients; however, this method does not detect some coronary artery anomalies. This case report demonstrates the significance of computed tomography (CT) angiography in identifying previously undiagnosed coronary abnormalities in a KD patient.

We herein describe a 7-year-old male who presented with symptoms consistent with KD and was treated subsequently with intravenous immune globulin (IVIG). Follow-up echocardiography showed no significant coronary artery abnormalities. Three years later, the patient presented with flu-like symptoms, and an ECG revealed anterolateral ischemic changes. Echocardiography showed normal coronary arteries. Nonetheless, a CT angiogram was performed due to the ischemic changes on ECG, and it identified a myocardial bridge in the left anterior descending artery, which had not been detected by echocardiography or ECG.

This case report emphasizes the importance of considering CT angiography as an adjunct imaging modality in the evaluation and follow-up of KD patients, particularly when echocardiographic findings are inconclusive or when clinical presentation raises concerns for potential coronary artery abnormalities. Further research is needed to establish evidence-based guidelines for the optimal timing and clinical indications for CT angiography in KD patients.