438.1 Kawasaki Disease

Daniel Bernstein

(See also Chapter 160.)

Aneurysms of the coronary or systemic arteries may complicate Kawasaki disease and are the leading cause of morbidity in this disease (Figs. 438-1 and 438-2 on the Nelson Textbook of Pediatrics website at www.expertconsult.com ). Other than in Kawasaki disease, aneurysms are not common in children and occur most frequently in the aorta in association with coarctation of the aorta, patent ductus arteriosus, and Marfan syndrome and in intracranial vessels (Chapter 594). They may also occur secondary to an infected embolus; infection contiguous to a blood vessel; trauma; congenital abnormalities of vessel structure, especially the medial wall; and arteritis, for example, polyarteritis nodosa, Behçet syndrome, and Takayasu arteritis (Chapter 161.2).

Figure 438-1 Two-dimensional echocardiogram comparing a normal left main coronary artery (arrow in A) with a giant coronary artery aneurysm (outlined by cross marks in B) in a patient with Kawasaki disease. Ao, aorta.

Figure 438-2 Pathologic specimen showing giant aneurysm of left main coronary artery (arrow). Ao, ascending aorta.

438.2 Arteriovenous Fistulas

Daniel Bernstein

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