Missed Kawasaki Disease Presenting as a Giant Coronary Aneurysm | JACC: Case Reports | ACC.25

Julien Dreyfus, MD, PhD, JACC: Case Reports Associate Editor, is joined by author Khalid Shakfeh, MD, discussing this study from Shakfeh et al presented at ACC.25 and published in JACC: Case Reports. A 56 year old man with chronic chest pain syndrome presented with sudden onset of weakness. Evaluation for a stroke revealed a large mass in the right atrium measuring approximately 2.2 x 2.0 cm immediately above the tricuspid valve annulus and adjacent to the atrio-ventricular groove on TTE. Cardiac MRI ruled out intracardiac mass, but rather demonstrated an RCA fusiform aneurysm. Coronary CTA characterized this as two fusiform RCA aneurysms. A LHC confirmed this. Giant coronary aneurysms appearing as a large space-occupying intracavitary cardiac mass are rarely diagnosed. Escalating multimodal imaging is essential for accurate diagnosis and surgical planning. Kawasaki disease can have a late presentation and should be considered in the differential diagnosis of coronary aneurysms. A multimodal imaging approach is essential for accurate diagnosis and management of giant coronary aneurysms.