2nd APLAR Grand Round 2022 Blackboard

Question 1

A 3-year-old boy presented with a history of fever for 7 days, redness in both eyes, maculopapular rash and swelling over hands and feet. He was diagnosed to have Kawasaki disease. Two-dimensional echocardiography was done to look for coronary artery abnormalities. Which of the following finding in two-Dimensional echocardiography suggests giant coronary artery aneurysms?

Your Answer is Incorrect

Answer with Detailed explanation

The correct answer is D) Z score >10

Kawasaki disease (KD) is a medium vessel vasculitis and coronary artery involvement is the hallmark complication in patients with KD. The American Heart Association (AHA) has recommended Z scores based on body surface area to classify coronary artery aneurysms.

Z-Score classification of coronary artery aneurysm

1. No involvement: Always <2
2. Dilation only: 2 to <2.5; or if initially <2, a decrease in Z score during follow-up ≥1
3. Small aneurysm: ≥2.5 to <5
4. Medium aneurysm: ≥5 to <10, and absolute dimension <8 mm
5. Large or giant aneurysm: ≥10, or absolute dimension ≥8 mm

Reference
McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017 Apr 25;135(17):e927-e999. doi: 10.1161/CIR.0000000000000484. Epub 2017 Mar 29. Erratum in: Circulation. 2019 Jul 30;140(5):e181-e184. PMID: 28356445.

By Prof Surjit Singh, Head, Department of Pediatrics and Chief, Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India