Abstract
Background: There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report herein the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations.Methods: This prospective observational study was carried out during the period January 2016–June 2017. Children underwent CTCA on 128-slice Dual Source CT (DSCT) scanner (Somatom Definition Flash, Siemens; Germany), and 2D-echocardiography on the same day.Results: Mean age at time of diagnosis was 6.52 ± 3.13 years; range 2–14 years. Mean age at time of study was 11.03 ± 5.10 years; range 3.75–23.30 years. Mean interval between diagnosis of KD and time of present study was 3.84 ± 2.27 years. None of the patients showed any coronary artery abnormalities on either 2D-echocardiography or CTCA. While assessment of proximal segments of left main coronary artery, proximal right coronary artery, and left anterior descending artery was comparable on both 2D-echocardiography and CTCA, left circumflex artery, and distal right coronary artery could be clearly visualized only on CTCA.Conclusion: In our experience, patients with KD who have spontaneous defervescence during the acute stage and do not receive IVIg may not have significant long-term coronary sequelae. CTCA is a useful imaging modality for delineation of coronary artery in patients with KD on long term follow-up especially in older children with thick chest walls and poor acoustic windows.
Highlights
Kawasaki disease (KD) is an acute, systemic childhood vasculitis syndrome that mainly affects small children and has a predilection for coronary arteries
Recent studies have shown that KD patients with spontaneous defervescence may not always have milder phenotypes of the disease—the converse may well be true as incidence of Coronary artery abnormalities (CAAs) in such situations may be higher than in patients who have been treated with intravenous immunoglobulin (IVIg) [13, 14]
We report the role of computed tomography coronary angiography (CTCA) on a 128-slice dual source CT (DSCT) platform in detecting CAAs in patients with KD who had spontaneous defervescence during the acute stage and did not receive IVIg for one or more reasons
Summary
KD is an acute, systemic childhood vasculitis syndrome that mainly affects small children and has a predilection for coronary arteries. Long-Term Follow-up of Kawasaki Disease still low [1,2,3,4,5,6]. Coronary artery abnormalities (CAAs) are known to develop in 15–25% of children with KD who do not receive appropriate and prompt treatment with IVIg. CAAs account for most of the morbidity and mortality associated with the disease [1, 7,8,9]. There is paucity of literature on long-term follow-up studies in children with KD who have had spontaneous defervescence. There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations
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