儿童川崎病冠状动脉瘤样扩张合并血栓1例
Journal of China-Japan Friendship Hospital(2021)
Abstract
患儿女,4岁,因"发热伴左颈部包块,发现冠状动脉扩张"就诊.患儿于就诊前21d无诱因发热,最高体温40℃,伴左颈部包块、局部皮肤发红、皮温高、有疼痛,外院考虑"颈淋巴结炎,脓毒血症",抗感染治疗后症状改善不明显,人院前8d(热程13d)患儿出现眼红、唇红皲裂,手肿等,临床诊断为川崎病(Kawasaki disease,KD)给予静脉丙种球蛋白(IVIG)总量2g/kg(1g/kg/d,共2d)、阿司匹林口服抗炎等治疗后热退.入院前1d外院超声心动图提示左冠脉主干及分支瘤样扩张,前降支内见中等回声附着,右冠状动脉近端瘤样扩张,管壁内膜增粗,诊断为左右冠状动脉瘤(coronary artery aneurysm,CAA).为进一步诊治收入我院.患儿无发热、胸闷,胸痛及心前区不适等症状.入院后查体:T 36.4℃,P 102次/min,R 20次/min,神清,精神可,未见皮疹,未扪及淋巴结肿大,未见杨梅舌.双肺呼吸音稍粗,心音有力、律齐,未闻及杂音.手足无硬肿发红,指端可见膜状脱屑.
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