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Priyadarshini Arunakumar, Anoop Ayyappan, Sivasankaran Sivasubramonian, Ajitkumar Valaparambil, Peripheral arterial aneurysms in a toddler, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 2, February 2018, Page 239, https://doi.org/10.1093/ehjci/jex249
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A 3-year-old child was referred for evaluation of a pulsatile swelling in the left axilla. He had a history of Kawasaki disease in the first year of life, treated with intravenous immunoglobulins and started on aspirin. After diagnosis of giant coronary artery aneurysms on echocardiogram, the child was started on warfarin. On physical examination, a small pulsatile swelling in the left axilla was detected. His ECG showed q waves in precordial leads V1–V4. Echocardiogram showed mild left ventricular dysfunction with regional wall motion abnormality involving the anterior wall and giant aneurysm involving the right coronary artery. He underwent MR angiography (Panels A and B), which showed multiple peripheral arterial aneurysms involving the left axillary, right common iliac, and left internal iliac arteries (shown in grey arrows). Non-contrast MR coronary angiograms (Panels C and D) showed giant right coronary artery aneurysm (9 × 14 mm) with evidence of thrombus (shown with a blue arrow). Additionally, an aneurysm (4 × 3.5 mm) involving the left main stem bifurcation (shown with a green arrow) was noted. Based on these findings coronary angiography and stress imaging are planned to determine further management. The case underscores the importance of evaluating peripheral arteries in patients with giant coronary aneurysms, as a sequel to Kawasaki disease.
