Key result
In a patient with refractory Kawasaki disease and giant coronary aneurysms, multimodality testing identified spontaneous echo contrast rather than thrombosis, preventing unnecessary thrombolytic therapy.
Why the study?
Coronary artery complications in Kawasaki disease increase long-term morbidity and mortality, and thrombosis can cause fatal outcomes requiring rapid diagnosis and aggressive treatment.
Case Report (n=1)
Accurate diagnosis of thrombosis through multiple tests is essential to prevent unnecessary thrombolytic therapy in patients with Kawasaki disease and giant coronary aneurysms.
Multimodality imaging may avoid unnecessary thrombolysis in Kawasaki giant aneurysms; case-report evidence leaves open prospective validation.
In Kawasaki disease, coronary artery complications increase the long-term morbidity and mortality. Coronary artery thrombosis can cause fatal outcomes, so rapid diagnosis and aggressive treatment are crucial. We report our experience of a patient with intravenous immunoglobulin-refractory Kawasaki disease who developed a giant coronary aneurysm. Despite high-dose immunoglobulin therapy, the patient developed giant coronary aneurysms measuring more than 10 mm in the left main coronary artery, left anterior descending artery, and right coronary artery. On echocardiography, hyperechogenic swirling with varying densities was observed , and antithrombotic agents were preemptively administered due to suspicion of thrombosis. However, the diagnosis of spontaneous echo contrast, rather than thrombosis, was made through a combination of tests including cardiac computerized tomography, fibrin degradation product, D-dimer, elektrokardiogramm, and regional wall motion abnormality on echocardiography. Accurate diagnosis of thrombosis through multiple tests is essential prevent unnecessary thrombolytic therapy.
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Shin et al. (2025) conducted a case report in Intravenous immunoglobulin-refractory Kawasaki disease with giant coronary aneurysm (n=1). High-dose immunoglobulin therapy and antithrombotic agents was evaluated on Diagnosis of spontaneous echo contrast vs thrombosis. In a patient with refractory Kawasaki disease and giant coronary aneurysms, multimodality testing identified spontaneous echo contrast rather than thrombosis, preventing unnecessary thrombolytic therapy.
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