What are the histologic features of Kawasaki disease affecting coronary arteries?

What are the histologic features of Kawasaki disease affecting coronary arteries?

• A. Transmural vasculitis of medium-sized arteries with aneurysm formation; coronary arteritis can lead to thrombosis
• B. Endocardial fibroelastosis
• C. Valvular vegetations
• D. Myxomatous degeneration of valve leaflets

Answer: (A)

Kawasaki disease produces a distinctive inflammatory process in the coronary arteries: a transmural vasculitis of medium-sized arteries with destruction across the entire vessel wall, leading to aneurysm formation. In the acute phase, fibrinoid necrosis and a mixed inflammatory infiltrate involve all layers of the arterial wall, weakening the wall and forming aneurysms. Over time, marked intimal proliferation and healing attempts can cause luminal narrowing or thrombosis, raising the risk of myocardial ischemia or infarction. This pattern matches the coronary involvement described in Kawasaki disease. Other options describe processes not characteristic of Kawasaki’s coronary pathology: endocardial fibroelastosis is thickening of the endocardium, not the arterial walls; valvular vegetations point to infective or Libman-Sacks endocarditis rather than coronary arteritis; myxomatous degeneration refers to changes in valve leaflets, not the arteries.

Kawasaki disease produces a distinctive inflammatory process in the coronary arteries: a transmural vasculitis of medium-sized arteries with destruction across the entire vessel wall, leading to aneurysm formation. In the acute phase, fibrinoid necrosis and a mixed inflammatory infiltrate involve all layers of the arterial wall, weakening the wall and forming aneurysms. Over time, marked intimal proliferation and healing attempts can cause luminal narrowing or thrombosis, raising the risk of myocardial ischemia or infarction. This pattern matches the coronary involvement described in Kawasaki disease.

Other options describe processes not characteristic of Kawasaki’s coronary pathology: endocardial fibroelastosis is thickening of the endocardium, not the arterial walls; valvular vegetations point to infective or Libman-Sacks endocarditis rather than coronary arteritis; myxomatous degeneration refers to changes in valve leaflets, not the arteries.