A Case of Seahorse Type Left Atrial Appendage Mimicking Left Coronary Artery Aneurysm in a 21 Month Old Boy with Kawasaki Disease

Background: Kawasaki disease (KD) described in 1967 is an illness with an unknown cause. It is one of the leading causes of acquired cardiovascular disease in the young. Female/male ratio is 1/1.5 and 80% of cases are under 5 years old. Coronary artery aneurysms (CAA) are the most important complications of KD with the highest rate in young infants. Risk factors for lack of regression of CAA are earlier age, larger CAA z score at diagnosis and bilateral CAA. There are five types of left atrial appendage (LAA) morphology in which seahorse type is the one with the lower risk of stroke, and may mimic a coronary fistula or aneurysm. Methods: In our case report, we evaluate a 21 months old boy who was admitted in hospital due to prolonged fever and with the Kawasaki diagnosis. Coronary artery aneurysm in left anterior descending (LAD) was seen in echocardiography. The patient received IVIG and ASA. Follow up continued by full echocardiography study which revealed no changes in LAD size. After a follow up for about two years under ASA therapy it was decided to do another diagnostic modality which CT angiography was accepted. Normal coronaries were reported in CT angiography surprisingly and more evaluation of CT angiography showed abnormal shape of LAA mimicking seahorse appearance which was misdiagnosis as LAD aneurysm. Results: There are different types of LAA morphology in which the seahorse type may mimic coronary artery fistula or aneurysm which we should consider in coronary artery evaluation in Kawasaki disease. Conclusions: Other diagnostic modalities are recommended in evaluating coronary arteries in Kawasaki disease when there is even a little doubt in the diagnosis of coronary artery aneurysms by suboptimal echo.

کلیدواژه ها:

seahorse left atrial appendage ، coronary artery aneurysm ، kawasaki disease