A 2-year-old has had 6 days of fever unresponsive to antibiotics. On examination: bilateral non-exudative conjunctival injection, fissured lips, strawberry tongue, non-tender cervical lymphadenopathy (1.5 cm), and an erythematous maculopapular rash. ECHO shows a left anterior descending coronary artery z-score of +2.7. This finding on ECHO classifies the coronary involvement as:

• A Small aneurysm (z-score 2.5–4.9) ✓
• B Normal; z-score <2.5 is the threshold for aneurysm
• C Medium aneurysm (z-score 5–9.9)
• D Dilation, not yet aneurysm (z-score 2–2.49)

Explanation

Per AHA 2017 Kawasaki disease guidelines, coronary artery z-scores are used to classify involvement: z-score <2 = normal; z-score 2–2.49 = dilation; z-score 2.5–4.9 = small aneurysm; z-score 5–9.9 = medium aneurysm; z-score ≥10 = large/giant aneurysm. A z-score of +2.7 for the LAD therefore classifies as a small coronary aneurysm. This is clinically significant and indicates the need for aspirin therapy (antiplatelet) and follow-up ECHO. Treatment with IVIG 2 g/kg single dose should be given promptly to reduce aneurysm risk further.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.