Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.
Aspirin ; Child ; Coronary Disease ; Diagnosis ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Scrotum* ; Systemic Vasculitis ; Testicular Hydrocele ; Transillumination ; Ultrasonography ; Urological Manifestations

We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.
Adolescent ; Ascites ; Child* ; Communicable Diseases ; Gallbladder Diseases* ; Gallbladder* ; Hospitalization ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome ; Retrospective Studies ; Ultrasonography

Neck mass can be frequently encountered in pediatric patients. Most neck mass in pediatric patients are either inflammatory lesions or benign tumors but their differential diagnoses are not always easy. We must not forget the study results that a considerable portion of pediatric neck mass constitutes malignant tumors. Generally neck mass can be divided into inflammatory, developmental (congenital), and tumorous lesions. Developmental neck mass are generally thyroglossal duct cyst, branchial cleft cyst, dermoid cyst, vascular malformation, or hemangioma. Manifestations of inflammatory neck mass are reactive cervical lymphadenopathy, infectious lymphadenitis (viral or bacterial), mycobacterial cervical lymphadenopathy, or Kawasaki disease. The more uncommonly found pediatric malignant neck mass are lymphoma, rhabdomyosarcoma, or thyroid carcinoma. For the diagnosis of pediatric neck mass complete blood count, purified protein derivative test for tuberculosis, and measurement of titers for Epstein-Barr virus are required and in special cases, infectious diagnostic panels for cat-scratch disease, cytomegalovirus, human immunodeficiency virus, or toxoplasmosis may be needed. Ultrasonography is the most convenient and feasible diagnostic method in differentiating various neck mass. Computed tomography is performed when identifying the anatomical aspects of the neck mass or where deep neck infection or retropharyngeal abscess is suspected. Surgical management for congenital neck mass is recommended to prevent secondary infection or various complications following size increase. Most pediatric neck mass originate from bacterial lymphadenitis and antibacterial therapy is considered first line of conservative treatment. However if the neck mass is either over 2 cm in size without any evidence of inflammation, firm or fixed to surrounding tissue, accompanied by B symptoms, unresponsive to initial antibacterial therapy or over 4 weeks of conservative management, or considered keep growing for over 2 weeks, one must suspect the possibility of malignancy and must consult a head and neck specialist for further detailed evaluation.
Blood Cell Count ; Branchioma ; Cat-Scratch Disease ; Coinfection ; Cytomegalovirus ; Dermoid Cyst ; Diagnosis ; Diagnosis, Differential ; Head ; Hemangioma ; Herpesvirus 4, Human ; HIV ; Humans ; Inflammation ; Lymphadenitis ; Lymphatic Diseases ; Lymphoma ; Mucocutaneous Lymph Node Syndrome ; Neck* ; Retropharyngeal Abscess ; Rhabdomyosarcoma ; Specialization ; Thyroglossal Cyst ; Thyroid Neoplasms ; Toxoplasmosis ; Tuberculosis ; Ultrasonography ; Vascular Malformations

Cardiac magnetic resonance (CMR) imaging is now widely used in several fields of cardiovascular disease assessment due to recent technical developments. CMR can give physicians information that cannot be found with other imaging modalities. However, there is no guideline which is suitable for Korean people for the use of CMR. Therefore, we have prepared a Korean guideline for the appropriate utilization of CMR to guide Korean physicians, imaging specialists, medical associates and patients to improve the overall medical system performances. By addressing CMR usage and creating these guidelines we hope to contribute towards the promotion of public health. This guideline is a joint report of the Korean Society of Cardiology and the Korean Society of Radiology.
Cardiomyopathies/diagnosis/radiography ; Cardiotonic Agents/therapeutic use ; Chest Pain/complications/diagnosis/radiography ; Coronary Artery Bypass ; Coronary Artery Disease/*diagnosis/drug therapy/radiography ; Dobutamine/therapeutic use ; Echocardiography ; Heart Defects, Congenital/diagnosis/radiography ; Heart Failure/diagnosis/ultrasonography ; Humans ; *Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome/complications/diagnosis ; Percutaneous Coronary Intervention ; Prognosis ; Risk Assessment ; Ventricular Function, Left/physiology

We report a 38-year-old man with previous Kawasaki disease who presented with exertional dyspnoea and was found to have multivessel coronary aneurysm and stenoses on coronary angiography. Coronary artery bypass surgery was subsequently performed. This case highlights the angiographic and intravascular ultrasonographic imaging features of this relatively uncommon condition presenting to an adult general cardiology service in Singapore.
Adult ; Coronary Aneurysm ; diagnosis ; etiology ; Coronary Angiography ; methods ; Coronary Stenosis ; diagnosis ; etiology ; Coronary Vessels ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Ultrasonography, Interventional ; methods

Anti-Inflammatory Agents ; therapeutic use ; Aspirin ; therapeutic use ; Child ; Facial Nerve Diseases ; diagnosis ; etiology ; Facial Paralysis ; diagnosis ; etiology ; Humans ; Immunoglobulins, Intravenous ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnostic imaging ; Platelet Aggregation Inhibitors ; therapeutic use ; Prednisolone ; therapeutic use ; Ultrasonography ; Warfarin ; therapeutic use

Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.
Coronary Aneurysm ; complications ; diagnosis ; Diagnosis, Differential ; Eye ; diagnostic imaging ; physiopathology ; Eye Diseases ; diagnosis ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Retinal Neoplasms ; complications ; diagnosis ; diagnostic imaging ; Retinoblastoma ; complications ; diagnosis ; diagnostic imaging ; Treatment Outcome ; Ultrasonography

Blood Flow Velocity ; Child ; Coronary Aneurysm ; diagnostic imaging ; Humans ; Mucocutaneous Lymph Node Syndrome ; diagnostic imaging ; Ultrasonography, Doppler

Aneurysm ; complications ; diagnostic imaging ; Child ; Coronary Aneurysm ; complications ; diagnostic imaging ; Humans ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnostic imaging ; Ultrasonography

The incidence of coronary artery disease requiring coronary intervention in patients with Kawasaki disease is high. Because coronary artery lesions in Kawasaki disease commonly involve severe calcification and aneurysmal changes which can progress with time, in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly applied. However, the experience of coronary intervention in Kawasaki disease is extremely limited compared to that with intervention in adults, which provides satisfactory therapeutic results. There are several kinds of percutaneous coronary intervention techniques in Kawasaki disease including balloon angioplasty, stent implantation, rotational ablation, and directional coronary atherectomy. Satisfactory acute results for coronary balloon angioplasty can be obtained in patients in a relatively short interval from the onset of disease, especially within 6 years. However, the incidence of restenosis after angioplasty is still high. Stent implantation acquires larger luminal area, less restenosis rate and less aneurysmal formation than balloon angioplasty. Rotational ablation is a good interventional option with high success rate for longstanding Kawasaki disease with severe calcification. Intravascular ultrasound imaging provides valuable information for the selection of the appropriate interventional procedure and the assessment of postprocedural outcomes. To obtain good result and optimal decision making, cooperation between pediatric and adult cardiologists is essential. Postprocedural anticoagulation or antiplatelet regimens are required for proper long-term management.
Adult ; Aneurysm ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Decision Making ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Percutaneous Coronary Intervention ; Phenobarbital ; Stents ; Ultrasonography