Congenital anomalies of coronary artery misdiagnosed as coronary dilatations in Kawasaki disease: A clinical predicament.

Rakesh Kumar Pilania, Pallavi L Nadig, Suprit Basu, Reva Tyagi, Abarna Thangaraj, Ridhima Aggarwal, Munish Arora, Arun Sharma, Surjit Singh, Manphool Singhal
{"title":"Congenital anomalies of coronary artery misdiagnosed as coronary dilatations in Kawasaki disease: A clinical predicament.","authors":"Rakesh Kumar Pilania, Pallavi L Nadig, Suprit Basu, Reva Tyagi, Abarna Thangaraj, Ridhima Aggarwal, Munish Arora, Arun Sharma, Surjit Singh, Manphool Singhal","doi":"10.5409/wjcp.v14.i1.99177","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>2D-echocardiography (2DE) has been the primary imaging modality in children with Kawasaki disease (KD) to assess coronary arteries.</p><p><strong>Aim: </strong>To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities (CAAs) on 2DE.</p><p><strong>Methods: </strong>Records of children diagnosed with KD, who underwent computed tomography coronary angiography (CTCA) at our center between 2013-2023 were reviewed. We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA. Findings of CTCA and 2DE were compared in these 3 children.</p><p><strong>Results: </strong>Of the 241 patients with KD who underwent CTCA, 3 (1.24%) had congenital coronary artery anomalies on CTCA detected incidentally. In all 3 patients, baseline 2DE had identified CAAs. CTCA was then performed for detailed evaluation as per our unit protocol. One (11-year-boy) amongst the 3 patients had complete KD, while the other two (3.3-year-boy; 4-month-girl) had incomplete KD. CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus [misinterpreted as dilated left main coronary artery (LCA) on 2DE], single coronary artery (interpreted as dilated LCA on 2DE) and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery. The latter one was subsequently operated upon.</p><p><strong>Conclusion: </strong>CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies. Relying solely on 2DE may not be sufficient in such cases, and findings from CTCA can significantly impact therapeutic decision-making.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"14 1","pages":"99177"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686587/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of clinical pediatrics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5409/wjcp.v14.i1.99177","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: 2D-echocardiography (2DE) has been the primary imaging modality in children with Kawasaki disease (KD) to assess coronary arteries.

Aim: To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities (CAAs) on 2DE.

Methods: Records of children diagnosed with KD, who underwent computed tomography coronary angiography (CTCA) at our center between 2013-2023 were reviewed. We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA. Findings of CTCA and 2DE were compared in these 3 children.

Results: Of the 241 patients with KD who underwent CTCA, 3 (1.24%) had congenital coronary artery anomalies on CTCA detected incidentally. In all 3 patients, baseline 2DE had identified CAAs. CTCA was then performed for detailed evaluation as per our unit protocol. One (11-year-boy) amongst the 3 patients had complete KD, while the other two (3.3-year-boy; 4-month-girl) had incomplete KD. CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus [misinterpreted as dilated left main coronary artery (LCA) on 2DE], single coronary artery (interpreted as dilated LCA on 2DE) and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery. The latter one was subsequently operated upon.

Conclusion: CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies. Relying solely on 2DE may not be sufficient in such cases, and findings from CTCA can significantly impact therapeutic decision-making.

川崎病冠状动脉先天性异常误诊为冠状动脉扩张:一个临床困境。
背景:二维超声心动图(2DE)已成为川崎病(KD)儿童评估冠状动脉的主要成像方式。目的:报道偶然先天性冠状动脉异常的存在和影响,这些异常被误认为是2DE的冠状动脉异常(CAAs)。方法:回顾2013-2023年在我中心接受ct冠状动脉造影(CTCA)诊断为KD的儿童的记录。我们在CTCA队列中发现了3名先天性冠状动脉异常的儿童。比较3例患儿的CTCA和2DE检查结果。结果:241例行CTCA的KD患者中,偶然发现先天性冠状动脉异常3例(1.24%)。在所有3例患者中,基线2DE均已确定CAAs。然后根据我们的单位方案进行CTCA进行详细评估。3例患者中1例(11岁男孩)为完全性KD,另外2例(3.3岁男孩;4个月大的女婴)患有不完全性KD。CTCA显示左前降支和左旋支与左窦分开起源[误译为2DE左侧主冠状动脉(LCA)扩张],单一冠状动脉(误译为2DE左侧主冠状动脉(LCA)扩张),当LCA与肺动脉主动脉起源异常时,在2DE右侧冠状动脉扩张。后一个人后来做了手术。结论:CTCA对KD患儿冠状动脉的详细评估是必要的,特别是在怀疑有先天性冠状动脉异常的情况下。在这种情况下,仅仅依靠2DE可能是不够的,CTCA的结果可以显著影响治疗决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
3.20
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信