Donuru Achala, Parekh Maansi, Kandula Vinay V R, Gould Sharon
Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA 19107, USA.
Department of Medical Imaging, Wilmington, DE 19803, USA.
Ann Pediatr Cardiol. 2020 Jul-Sep;13(3):267-268. doi: 10.4103/apc.APC_6_20. Epub 2020 Jun 11.
A 3-year-old male presents to the emergency department with chief complaints of fever and vomiting. He had a positive rapid streptococcus throat test with cervical lymphadenopathy. The patient was started on antibiotics. On examination, there was diffuse erythematous macular rash on the chest. Laboratory tests revealed elevated white cell count and C-reactive protein. Electrocardiogram was notable for prolonged PR interval indicating 1 degree atrioventricular block. Echocardiogram revealed ectasia of the right coronary artery (RCA). A presumptive diagnosis of Kawasaki disease was made and the patient was started on high-dose aspirin and intravenous immunoglobulins. Cardiac computed tomography angiography (CTA) showed an aneurysm of the proximal RCA measuring up to 7.4 mm. The RCA immediately proximal to the aneurysm measured 3 mm in diameter. The Z score was 13.4. Oblique coronal image from cardiac CTA and volume rendered images demonstrated an aneurysm of the proximal RCA. The patient improved with treatment.
一名3岁男性因发热和呕吐为主诉就诊于急诊科。他的快速链球菌咽拭子检测呈阳性，伴有颈部淋巴结病。患者开始使用抗生素治疗。检查时，胸部出现弥漫性红斑丘疹。实验室检查显示白细胞计数和C反应蛋白升高。心电图显示PR间期延长，提示一度房室传导阻滞。超声心动图显示右冠状动脉（RCA）扩张。初步诊断为川崎病，患者开始使用大剂量阿司匹林和静脉注射免疫球蛋白治疗。心脏计算机断层扫描血管造影（CTA）显示近端RCA动脉瘤，最大直径达7.4 mm。动脉瘤近端紧邻的RCA直径为3 mm。Z评分为13.4。心脏CTA的斜冠状位图像和容积再现图像显示近端RCA动脉瘤。患者经治疗后病情好转。
