(Circulation. 1998;98:2216-2217.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Giant Coronary Artery Calcification
From the Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
An 11-year-old boy presented with giant
calcifications on the chest radiograph, detected during screening for
heart disease (Figure
). He had been
diagnosed with measles twice, at 1 and 2 years of age. Before this
screening, he had been asymptomatic. An ECG revealed sinus
rhythm and no specific ST-T–wave changes. The CT scan showed 2 giant
circular masses at the atrioventricular sulcus of the
right coronary artery. A 2-dimensional echocardiogram showed
bilateral coronary aneurysms, with high echogenicity of
the proximal right coronary artery. The left
ventricular systolic and diastolic
functions were normal. Right coronary arteriographs showed a
total occlusion of the right coronary artery just proximal to
the giant aneurysm. Left coronary arteriographs showed
a mild dilatation of the proximal left main trunk and a segmental
stenosis of the left anterior descending coronary
artery. The left circumflex artery was well developed and supplied the
distal right coronary artery as a collateral circulation.
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It has been almost 30 years since Kawasaki disease was first reported in Japan. A substantial number of patients with this disease have reached adulthood. In the long-term follow-up of these older patients with coronary stenotic lesions due to Kawasaki disease, circular or ring-shaped coronary artery calcification is occasionally a distinctive feature.1 2 3 4 In this patient, Kawasaki disease had never been suspected, but measles was diagnosed twice, at 1 and 2 years of age. This evidence was crucial for the differential diagnosis of calcification in the heart. Therefore, coronary arteriography should be performed to evaluate the stenotic lesion if this type of calcification is found by routine radiographic examination. In addition, fluoroscopy was useful for the diagnosis of coronary calcification because of the synchronized pattern with the heart beat.
Footnotes
Reprint requests to Toshihiro Ino, MD, Director, Department of Pediatrics, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
References
1. Ino T, Shimazaki S, Akimoto K, Park I, Nishimoto K, Yabuta K, Tanaka A. Coronary artery calcification in Kawasaki disease. Pediatr Radiol. 1990;20:520–523.[Medline] [Order article via Infotrieve]
2.
Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno
Y, Kazue T, Eto G, Yamakawa R. Long-term consequences of Kawasaki
disease: a 10- to 21-year follow-up study of 594 patients.
Circulation. 1996;94:1379–1385.
3. Suzuki A, Kamiya T, Arakaki Y, Kinoshita Y, Kimura K. Fate of coronary arterial aneurysms in Kawasaki disease. Am J Cardiol. 1994;74:822–824.[Medline] [Order article via Infotrieve]
4. Kato H, Inoue O, Kawasaki T, Fujiwara H, Watanabe T, Toshima H. Adult coronary artery disease probably due to childhood Kawasaki disease. Lancet. 1992;340:1127–1129.[Medline] [Order article via Infotrieve]
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