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Kawasaki Disease Imaging

January 23, 2019

Overview

 

Kawasaki disease is an acute febrile illness associated with multiorgan vasculitis of unknown etiology that primarily affects infants and children. [1, 2, 3, 4] The disease probably has existed for a long time, but it was not recognized as a separate entity until Dr Tomisaku Kawasaki first described it in 1967. [5] Kawasaki disease was later reported in the English-language literature in 1974. [6]

 

Kawasaki disease is a multiorgan disease. During the acute phase, children may develop aseptic meningitis, hyperemic tympanic membrane, or uveitis. Neurologic complications, which include facial nerve palsy, seizures, and ataxia cerebral infarctions, are rare. Other common features include diarrhea, vomiting, abdominal pain, and pneumonitis. Gallbladder hydrops (acute acalculous distention of the gallbladder; see image below) may occur in the first 2 weeks of illness, it may be the result of the extension of periportal inflammation to the cystic duct, and it is typically self-limited. Arthritis and arthralgia are common in the acute phase. Findings that include erythema and induration at the site of recent Bacille Calmette-Guérin vaccination, testicular swelling, and peripheral gangrene also have been reported in patients with this disease.

 

Kawasaki disease. Sonogram of the right upper quadrant shows hydrops of the gallbladder. Note the size of the gallbladder compared with that of the inferior vena cava. Courtesy of Dr S. Methratta, UMDNJ-New Jersey Medical School.

 

The ECG is usually normal.

 

Radiography

 

Chest radiography is not routinely performed to evaluate for Kawasaki disease, and the results are often normal. [7]

If coronary aneurysm and calcification of the coronary artery aneurysm wall are present, they may be detected as cystic calcification in the region of the coronary vessels, overlying the heart shadow.

Computed Tomography

 

CT is not routinely performed for the evaluation of Kawasaki disease; however, CT is more sensitive than chest radiography in detecting coronary calcifications. Contrast-enhanced CT may demonstrate enhancement of the vessel walls in the coronaries, particularly in the acute phase. [8]

 

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