Aneurysms of the cornary arteries form in up to one-quarter of patients with untreated Kawasaki disease, and are of concern because of late thrombosis and myocardial infarction, particularly those that exceed 8 millimetres in diameter, which can be considered giant coronary aneurysms. Non-invasive imaging is valuable for serial follow-up of such patients. We show images from a 15-year-old boy with an aneurysm of the main stem of the left coronary artery detected on echocardiography, but with its distal extent beyond the range of the ultrasonic probe. Cardiovascular magnetic resonance coronary angiography was able to demonstrate the proximal 8.3 centimetres of the aneurysmal left coronary artery, with a pixel size of 1.1 by 0.7 by 0.5 millimetres in a … in a breath hold, steady state free precession coronary sequence (Fig.). Each of the four images shown here (A, B, C, and D) was piloted by successively cross-cutting the previous one along the dotted lines shown. The aneurysm commenced 5 millimetres from the orifice of the artery, and measured 33 by 16 millimetres. Proximal to the aneurysm, the origin of the left main stem measured 3 by 5 millimetres and, distal to it, the diameter of the left anterior descending artery was 3 by 4 millimetres. It was reassuring that a patent lumen was seen distal to the aneurysm (arrow in panels C and D). Cine cardiovascular magnetic resonance showed no regional abnormality of the ventricular wall, and the late gadolinium study showed no evidence of late enhancement, excluding damage to the myocardial tissues. Close follow-up of this single giant aneurysm is required, nonetheless, because of the risk of coronary arterial stenoses. As illustrated by this patient, cardiovascular magnetic resonance provides accurate, non-invasive imaging, which may reduce the frequency of, or obviate the need for, ionising radiation from repeated cardiac catheterization, radioisotope myocardial perfusion imaging, or cardiac computerised tomography. A potential limiting factor in younger patients may be the need to employ sedation or anaesthesia so as to obtain the necessary cooperation to achieve a complete study.

Figure 1.