Kawasaki disease echocardiography and ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

An echocardiogram may be helpful in the diagnosis of Kawasaki disease. Findings on an echocardiogram suggestive of Kawasaki disease include coronary artery dilatation, stenosis or aneurysms, left ventricular dysfunction, pericardial effusion, and mitral regurgitation.

Echocardiography/Ultrasound

Echocardiography

An echocardiogram may be helpful in the diagnosis of Kawasaki disease. Findings on an echocardiogram suggestive of Kawasaki disease include:

Echocardiographic Views of Coronary Arteries in Patients With Kawasaki Disease

Adapted from the AHA Scientific Statement on the diagnosis, treatment, and long term management of Kawasaki disease[2]
LMCA Precordial short axis at level of aortic valve; precordial long axis of left ventricle (superior tangential); subcostal ventricular long axis
LAD coronary artery Precordial short axis at level of aortic valve; precordial superior tangential long axis of left ventricle; precordial short axis of left ventricle
Left circumflex branch Precordial short axis at level of aortic valve; apical 4-chamber
RCA, proximal segment Precordial short axis at level of aortic valve; precordial long axis (inferior tangential) of left ventricle; subcostal coronal projection of right ventricular outflow tract; subcostal short axis at level of atrioventricular groove
RCA, middle segment Precordial long axis of left ventricle (inferior tangential); apical 4-chamber; subcostal left ventricular long axis; subcostal short axis at level of atrioventricular groove; RCA proximal (#1) and mid (#2) are observed in the atrioventricular groove from the third intercostal space at the left and right sternal border
RCA, distal segment Apical 4-chamber (inferior); subcostal atrial long axis (inferior)
Posterior descending coronary artery Apical 4-chamber (inferior); subcostal atrial long axis (inferior); precordial long axis (inferior tangential) imaging; posterior interventricular groove
KD indicates Kawasaki disease; LAD, left anterior descending; LMCA, left main coronary artery; and RCA, right coronary artery

AHA Recommendations for Cardiovascular Assessment for Diagnosis and Monitoring During the Acute Illness

The AHA recommendations for cardiovascular assessment for diagnosis and monitoring during the acute illness are:[2]

Class I
"1. Echocardiography should be performed when the diagnosis of Kawasaki Disease is considered, but unavailability or technical limitations should not delay treatment (Class I; Level of Evidence B).
"2. Coronary arteries should be imaged, and quantitative assessment of luminal dimensions, normalized as Z scores adjusted for body surface, should be performed (Class I; Level of Evidence B).
"3. For uncomplicated patients, echocardiography should be repeated both within 1 to 2 weeks and 4 to 6 weeks after treatment (Class I; Level of Evidence B).
"4. For patients with important and evolving coronary artery abnormalities (Z score >2.5) detected during the acute illness, more frequent echocardiography (at least twice per

week) should be performed until luminal dimensions have stopped progressing to determine the risk for and presence of thrombosis (Class I; Level of Evidence B).

Class IIa
"1. To detect coronary artery thrombosis, it may be reasonable to perform echocardiography for patients with expanding large or giant aneurysms twice per week while dimensions are expanding rapidly and at least once weekly in the first 45 days of illness, and then monthly until the third month after illness onset, because the failure to escalate thrombo-prophylaxis in time with the rapid expansion of aneurysms is a primary cause of morbidity and mortality (Class IIa; Level of Evidence C).

Ultrasound

Ultrasound may show hydrops (enlargement) of the gallbladder.

References

  1. 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 (April 2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. PMID 28356445.
  2. 2.0 2.1 McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.

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