144 - THROMBOTIC CALCIFIED ANEURYSM IN A CHILD WITH KAWASAKI DISEASE AT 4 YEARS OF FOLLOW-UP

Case details:

An 8-year-old boy was diagnosed with Kawasaki disease (KD) at the age of 4 years. He received intravenous immunoglobulin (2 g/kg) along with oral aspirin. At the time of presentation, transthoracic echocardiography (TTE) revealed a saccular aneurysm in the left main coronary artery (LCA) measuring 7.7 mm in diameter, a dilated left anterior descending (LAD) artery (12.6mm in diameter) and a right coronary artery (RCA) aneurysm (4.0 mm in diameter). He was started on warfarin, and low-dose aspirin was continued.

            CT Coronary angiography (CTCA) performed 4 years on follow-up showed dilated proximal RCA (2.8mm) and two fusiform aneurysms in mid-RCA (3.5 mm and 3.2 mm) along with mural calcifications. There was a fusiform aneurysm in distal LCA (8.4mmx12.5mm) extending into the proximal left circumflex coronary artery (LCx) and ramus intermedius coronary artery. A densely calcified saccular aneurysm (12.6mmx15.6mm) filled with hypodense contents suggestive of thrombus was visible in the LAD beyond its origin. Mid and distal segments of the LAD were markedly attenuated and showed bare opacification (likely from collaterals). Agatston's calcium scoring was 497, indicating a coronary age of more than 70 years (Figure 1).        

             This case emphasises the importance of CTCA in delineating the intricacy of coronary artery abnormalities in children with KD. This degree of coronary artery calcification within 4 years follow-up suggests that the calcification of KD aneurysms is dystrophic in origin.