A 4-year-old male has had fever for 7 days, bilateral conjunctival injection, cracked lips, polymorphous rash, and cervical lymphadenopathy. Echocardiography is performed. Which coronary artery finding on echo, if present, classifies the child as having a GIANT coronary artery aneurysm (CAA) in Kawasaki disease?

• A Internal diameter ≥ 4 mm
• B Z-score ≥ 2.5 regardless of absolute diameter
• C Any dilatation >1.5× the adjacent normal segment
• D Internal diameter > 8 mm (or Z-score > 10) ✓

Explanation

Per the 2017 AHA Kawasaki disease scientific statement, coronary artery aneurysms are classified by Z-score and absolute diameter: Small = Z-score 2–4.99 and diameter <4 mm; Medium = Z-score 5–9.99 (or absolute diameter 4–7.9 mm in children ≥2 years); Large/Giant = Z-score ≥10 OR absolute internal diameter ≥8 mm. Giant aneurysms carry the highest thrombosis and stenosis risk and require long-term anticoagulation plus antiplatelet therapy. IVIG resistance is the primary predictor of giant CAA development.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.