We reviewed the chest x-ray (CXR) findings and clinical courses of 129 patients with Kawasaki disease and found abnormal CXR findings in 14.7% of the patients. Reticulogranular pattern was the most frequent abnormality (89.5%), while peribronchial cuffing (21.1%), pleural effusion (15.8%), atelectasis (10.5%) and air trapping (5.3%) were also seen. In each of these patients, CXR abnormalities appeared within 10 days after the onset of illness. In the group with abnormal CXR findings, a statistically significant increase was noted in duration of fever, incidence of adventitious sounds, serum CRP levels and incidence of coronary arterial lesions and pericardial effusion, as compared with the group having normal CXR findings. The pathological basis of these CXR changes is not clear, since no biopsy or autopsy specimen was obtained from these patients, none of these patients showed definite heart failure, it is difficult to consider that abnormal CXR findings were due to heart failure. On the other hand, physical signs and previous pathological reports suggested that the causes of abnormal CXR findings were lower respiratory tract inflammation and/or pulmonary arteritis.

Myocardial imaging with gallium-67 citrate was used to detect myocarditis in 46 consecutive infants and children (31 boys and 15 girls, mean age 21 months) with Kawasaki disease. In all of them planar imaging (group A) was performed at 6 hours and at 48 or 72 hours after the intravenous administration of a mean (SD) dose of gallium-67 citrate (0.07 (0.02) mCi/kg). Thirty four patients (24 boys and 10 girls, mean age 21 months) also had single photon emission computed tomography imaging (group B) soon after planar imaging. The patients had been ill for from 5 days to 16 days (mean (SD) 10.5 (2.4) days in group A and 10.6 (3.0) days in group B). The colour images obtained at 48 or 72 hours were positive in 41% of group A and in 64% of group B. Among the patients with clinically suspected myocarditis, 63% in group A and 80% in group B had positive myocardial images. Single photon emission computed tomography imaging permitted the identification of tracer in the myocardium, the pericardium only, or in the heart chambers. Myocardial imaging with gallium-67 citrate, especially when used with single photon emission computed tomography imaging, is useful for the detection of myocarditis in the acute phase of Kawasaki disease.

The case of a 4-year-old boy with dipyridamole-induced ischemia is herein reported. The patient developed typical Kawasaki syndrome at 2 years of age, accompanied by coronary aneurysms in the left coronary artery (LCA) and the right coronary artery (RCA). The LCA was totally occluded at segment 6 and a distal area of the left anterior descending artery (LAD) was supplied by collaterals from the conus branch and the posterior descending artery (PD). Thallium-201 (T1-201) myocardial scintigraphy was performed with intravenous administration of dipyridamole (DIP). DIP was infused at a dosage of 0.6 mg/kg for 5min. Three minutes after the injection, myocardial ischemia occurred. Although 4mg/kg of aminophyllin was administered, the symptoms lasted for 20min. Electrocardiogram suggested that ischemic lesions were located in the anteroseptal and inferior wall. Collaterals from PD could be recognized as jeopardized vessels and these collaterals probably participated in the ischemic attack. DIP could have increased the coronary flow into the uninvolved proximal branches of RCA. Subsequently DIP reduced coronary flow in the distal region of the stenotic RCA. Although T1-201 myocardial scintigraphy with DIP is a useful technique to estimate viability of the ischemic myocardium, it should be performed prudently in patients with multivessel diseases, such as those with jeopardized collaterals secondary to Kawasaki syndrome.

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