A 4-year-old male presents with 7 days of fever, conjunctival injection, cracked lips, strawberry tongue, rash and cervical lymphadenopathy >1.5 cm. Echocardiogram shows left anterior descending coronary artery diameter of 4.8 mm (z-score +3.2). Which statement about the management of this child's coronary findings is MOST accurate?

• A Coronary involvement at this level requires no specific long-term treatment beyond 6 weeks
• B This degree of involvement is classified as a medium aneurysm and warrants anticoagulation with warfarin
• C Coronary abnormalities in Kawasaki resolve spontaneously in all cases without therapy
• D Z-score >2.5 defines small coronary aneurysm and requires antiplatelet therapy with aspirin ✓

Explanation

In Kawasaki disease, the American Heart Association classifies coronary artery aneurysms by z-score: small (z = 2.0–2.5), medium/small (z = 2.5–5 or absolute diameter <5 mm in children <5 years), large/giant (z ≥10 or absolute >8 mm). A z-score of +3.2 with absolute diameter 4.8 mm (small-to-medium aneurysm in a 4-year-old). All patients with coronary involvement receive long-term low-dose aspirin antiplatelet therapy. Anticoagulation (warfarin or low-molecular-weight heparin) is added only for large or giant aneurysms (z ≥10). Not all coronary aneurysms resolve without therapy.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.