Pilania RK, Nadig PL, Basu S, Tyagi R, Thangaraj A, Aggarwal R, Arora M, Sharma A, Singh S, Singhal M. Congenital anomalies of coronary artery misdiagnosed as coronary dilatations in Kawasaki disease: A clinical predicament. World J Clin Pediatr 2025; 14(1): 99177 [PMID: 40059891 DOI: 10.5409/wjcp.v14.i1.99177]
Corresponding Author of This Article
Manphool Singhal, DNB, MD, Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, Chandīgarh, India. drmsinghal74@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rakesh Kumar Pilania, Pallavi L Nadig, Suprit Basu, Reva Tyagi, Abarna Thangaraj, Ridhima Aggarwal, Munish Arora, Surjit Singh, Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, Chandīgarh, India
Arun Sharma, Manphool Singhal, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandīgarh, India
Author contributions: Pilania RK, Nadig PL, Singhal M contributed to inception of idea, writing of initial draft, editing, and revision of the manuscript, and review of the literature; Pilania RK and Nadig PL contribute equally; Nadig PL, Basu S, Tyagi R, Thangaraj A, Aggarwal R, Arora M contributed to patient evaluation, management and follow-up, editing, and revision of the manuscript, acquisition of clinical photographs; Pilania RK, Sharma A, Singh S, Singhal M contributed to editing and revision of the manuscript and patient evaluation and management and overall supervision of manuscript preparation. All authors have read and approved the manuscript.
Institutional review board statement: The study is reviewed and approved by the Departmental Review Board [Approval number- RDG/EC/Pub/08 (dated 08/02/2024)].
Informed consent statement: Parents of patients given written informed consent for CT coronary angiography. Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained from the review of records.
Conflict-of-interest statement: Authors declare no conflicts of interest.
Data sharing statement: Data sharing statement: The data underlying this article are available in the manuscript and our records. These data can be shared on request.
Corresponding author: Manphool Singhal, DNB, MD, Professor, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, Chandīgarh, India. drmsinghal74@gmail.com
Received: July 15, 2024 Revised: October 8, 2024 Accepted: November 12, 2024 Published online: March 9, 2025 Processing time: 157 Days and 13.3 Hours
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.
Core Tip: Congenital coronary artery anomalies are liable to be misinterpreted as coronary artery abnormalities (CAAs) on 2D-echocardiography in children with Kawasaki disease. Computed tomography coronary angiography is essential for the detailed evaluation of coronary arteries.
